A recently obtained report authored by the non-partisan Congressional Research Service (CRS) raises questions about the Independent Payment Advisory Board (IPAB), a draconian Medicare cost-cutting mechanism created by the new health care reform law, the Patient Protection and Affordable Care Act (PPACA).

The reform law created the IPAB as a novel and aggressive mechanism to “reduce the per capita rate of growth in Medicare spending.” The Board, composed of 15 members appointed by the President, is charged with developing proposals to maintain Medicare spending below a targeted per capita growth rate.  In a process reminiscent of that used for the Defense Base Realignment and Closure (BRAC) Commission, the Board’s proposals receive special expedited and protected consideration by Congress.  The process spelled out in the statute creates a number of barriers that inhibit Congress’ ability to reject or defeat any proposed Medicare cuts.    

The CRS report highlights that the IPAB provision may be open to legal challenges because the law shifts the “balance of power to the executive branch and away from Congress.” The report also questions how the IPAB procedures will impact House and Senate parliamentary procedures and the constitutional rights of both chambers. 

Currently, the constitutionality of the Board is being challenged in federal district court in Arizona by the Goldwater Institute.

ASA opposed the inclusion of IPAB during the health system reform debate and currently supports repeal of the provision creating the Board.