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114th Congress, Vote 376; House of Representatives #1190

Protecting Seniors' Access to Medicare Act of 2015

Official Title: To repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board.

HR 1190: Repealing the Independent Payment Advisory Board (IPAB)
Passed by the House Jun 23, 2015, 244-154 (35 abstaining).

Synopsis: The ACA established the Independent Payment Advisory Board (IPAB), a panel of 15 health care experts tasked with recommending cost-containment measures if annual Medicare per-capita spending growth is projected to exceed a target rate.

Despite the fact that the IPAB was the basis for the "death panel" fear-mongering from ACA opponents, the IPAB's recommendations cannot call for the rationing of care, reduction of benefits, or anything that would shift costs onto Medicare beneficiaries.

Prior to 2020, the IPAB would not be able to recommend payment cuts to hospitals, home health agencies, long-term acute care facilities, or hospices, although payment cuts to physicians would be allowed. It's important to note however, that the IPAB would be able to draft creative, thoughtful solutions to spending problems. As an example, it could recommend increasing payments for the most cost-effective treatments as a way to encourage those treatments. In other words, it has more tools available than simply cutting provider reimbursements.

CMS is responsible for projecting the coming year's projected Medicare spending growth rate, and if it is expected to exceed the target amount, the IPAB would develop a proposal for spending cuts. The IPAB was originally set to convene in 2014, but the projected Medicare spending growth rate for 2014 was low enough that no action was necessary. IPAB panel members are to be appointed by the President and confirmed by the Senate, but as of mid-2015, there have been no appointments.

Under existing law – since the IPAB has not yet convened – changes to Medicare spending are recommended by the Medicare Payment Advisory Commission (MedPAC), but must be approved by Congress in order to be implemented, as MedPAC has no regulatory authority.

Under the ACA, if Congress fails to pass other measures to create the required spending cuts, recommendations made by the IPAB would be implemented automatically unless they are rejected by a supermajority vote in Congress.

The House previously passed a bill that included IPAB repeal in 2012, but it didn't advance in the Senate, which had a Democratic majority at the time.

Why supporters pushed for this bill

  • Since the IPAB is not permitted recommend cost-sharing, eligibility, or benefit modifications, critics note that none of the cost-savings will be generated through reduced utilization of healthcare. They believe the IPAB has few options other than reducing payments to providers, and there is concern that some physicians might opt out of Medicare if that happens. The American Medical Association and many other physician organizations have long called for repeal of the IPAB.
  • Some opponents of the the IPAB see it as unfairly targeting physicians, since hospitals and other healthcare facilities are initially exempt from IPAB recommendations (although it should be noted that the IPAB is not expected to have to make any recommendations during the first few years, due to low projected Medicare spending growth).
  • Since IPAB panel members are appointed rather than elected, they would not be accountable to voters. IPAB opponents initiated a lawsuit claiming that the IPAB would illegally remove power from Congress; in March 2015, the Supreme Court declined to hear it.

Why opponents tried to stop the bill

  • The IPAB could help usher in common-sense financial reforms for Medicare spending that might not otherwise make it through Congress due to heavy lobbying from special interest groups (things like competitive bidding for Medicare-funded durable equipment, and allowing Medicare to negotiate drug prices with manufacturers have been shut down in the past by special interest lobbying).
  • The Congressional Budget Office estimated that repealing the IPAB would result in $7.1 billion in increased spending during the 2022 to 2025 period, although CBO predicted no budgetary impact between 2015 and 2021. (The IPAB is not expected to have to make cost-cutting recommendations during those years due to low projected spending growth.)
  • The Center for Budget and Policy Priorities explains that the IPAB will be an effective cost-containment program, and that concerns about the IPAB usurping control from Congress are overblown, since Congress would have the option to implement their own proposals, as long as they contain adequate cost-saving measures.
  • IPAB supporters note that it's meant to be a fail-safe rather than a primary means of cost-containment. A primary tenant of the ACA is to transition Medicare payments away from fee-for-service and towards more value-based payment systems. The IPAB would only have to step in if that doesn?t work.
  • Advocates of repealing the IPAB have not proposed a viable alternative that would achieve the cost-containment necessary for the long-term solvency of the Medicare program. Repealing the IPAB would make the introduction of a privatized Medicare system (eg, vouchers) more likely, and thus shift far more costs onto beneficiaries.
06/23/2015 Status: House passed

More: select a member to see his or her other key health care votes.

Yes (244)
R Don Young AK
R Mo Brooks AL
R Bradley Byrne AL
R Gary Palmer AL
R Martha Roby AL
R Mike Rogers AL
R Eric Crawford AR
R French Hill AR
R Bruce Westerman AR
R Steve Womack AR
R Trent Franks AZ
R Paul Gosar AZ
R Martha McSally AZ
R Matt Salmon AZ
R David Schweikert AZ
D Kyrsten Sinema AZ
R Ken Calvert CA
R Jeff Denham CA
R Duncan Hunter CA
R Darrell Issa CA
R Steve Knight CA
R Doug LaMalfa CA
R Kevin McCarthy CA
R Tom McClintock CA
R Devin Nunes CA
R Edward Royce CA
R David Valadao CA
R Mimi Walters CA
R Ken Buck CO
R Mike Coffman CO
R Doug Lamborn CO
R Scott Tipton CO
R Gus Bilirakis FL
R Vern Buchanan FL
R Curtis Clawson FL
R Ander Crenshaw FL
R Carlos Curbelo FL
R Mario Diaz-Balart FL
D Gwen Graham FL
R David Jolly FL
R John Mica FL
R Jeff Miller FL
R Richard Nugent FL
R Bill Posey FL
R Thomas Rooney FL
R Ileana Ros-Lehtinen FL
R Dennis Ross FL
R Daniel Webster FL
R Ted Yoho FL
R Rick Allen GA
R Buddy Carter GA
R Doug Collins GA
R Tom Graves GA
R Jody Hice GA
R Barry Loudermilk GA
R Tom Price GA
R Austin Scott GA
D David Scott GA
R Rob Woodall GA
D Tulsi Gabbard HI
R Rod Blum IA
R Steve King IA
R David Young IA
R Raúl Labrador ID
R Michael Simpson ID
R Mike Bost IL
R Rodney Davis IL
R Bob Dold IL
D Bill Foster IL
R Randy Hultgren IL
R Adam Kinzinger IL
R Peter Roskam IL
R John Shimkus IL
R Susan Brooks IN
R Larry Bucshon IN
R Luke Messer IN
R Todd Rokita IN
R Marlin Stutzman IN
R Jackie Walorski IN
R Todd Young IN
R Tim Huelskamp KS
R Lynn Jenkins KS
R Mike Pompeo KS
R Kevin Yoder KS
R Garland Barr KY
R Brett Guthrie KY
R Thomas Massie KY
R Harold Rogers KY
R Ed Whitfield KY
R Ralph Abraham LA
R Charles Boustany LA
R John Fleming LA
R Garret Graves LA
R Steve Scalise LA
D Michael Capuano MA
D Richard Neal MA
R Andy Harris MD
R Bruce Poliquin ME
R Justin Amash MI
R Dan Benishek MI
R Mike Bishop MI
R Bill Huizenga MI
R Candice Miller MI
R John Moolenaar MI
R Dave Trott MI
R Fred Upton MI
R Tim Walberg MI
R Tom Emmer MN
R John Kline MN
R Erik Paulsen MN
D Collin Peterson MN
R Sam Graves MO
R Vicky Hartzler MO
R Billy Long MO
R Blaine Luetkemeyer MO
R Jason Smith MO
R Gregg Harper MS
R Steven Palazzo MS
R Ryan Zinke MT
R Renee Ellmers NC
R Virginia Foxx NC
R George Holding NC
R Richard Hudson NC
R Walter Jones NC
R Patrick McHenry NC
R Mark Meadows NC
R Robert Pittenger NC
R David Rouzer NC
R Mark Walker NC
R Kevin Cramer ND
D Brad Ashford NE
R Jeff Fortenberry NE
R Adrian Smith NE
R Frank Guinta NH
R Rodney Frelinghuysen NJ
R Scott Garrett NJ
R Leonard Lance NJ
R Frank LoBiondo NJ
R Tom MacArthur NJ
R Christopher Smith NJ
R Stevan Pearce NM
R Mark Amodei NV
R Cresent Hardy NV
R Joseph Heck NV
R Chris Collins NY
R Daniel Donovan NY
R Christopher Gibson NY
R Richard Hanna NY
R John Katko NY
R Peter King NY
D Sean Maloney NY
R Tom Reed NY
R Elise Stefanik NY
R Lee Zeldin NY
R Steve Chabot OH
R Bob Gibbs OH
R Bill Johnson OH
R Jim Jordan OH
R David Joyce OH
R Robert Latta OH
R James Renacci OH
R Steve Stivers OH
R Patrick Tiberi OH
R Michael Turner OH
R Brad Wenstrup OH
R Jim Bridenstine OK
R Tom Cole OK
R Frank Lucas OK
R Markwayne Mullin OK
R Greg Walden OR
R Lou Barletta PA
R Ryan Costello PA
R Charles Dent PA
R Michael Fitzpatrick PA
R Mike Kelly PA
R Patrick Meehan PA
R Tim Murphy PA
R Scott Perry PA
R Joseph Pitts PA
R Keith Rothfus PA
R Bill Shuster PA
R Glenn Thompson PA
R Jeff Duncan SC
R Trey Gowdy SC
R Mick Mulvaney SC
R Tom Rice SC
R Marshall Sanford SC
R Joe Wilson SC
R Kristi Noem SD
R Diane Black TN
R Marsha Blackburn TN
R Scott DesJarlais TN
R John Duncan TN
R Charles Fleischmann TN
R David Roe TN
R Brian Babin TX
R Joe Barton TX
R Kevin Brady TX
R Michael Burgess TX
R K. Conaway TX
R John Culberson TX
R Blake Farenthold TX
R Bill Flores TX
R Louie Gohmert TX
R Kay Granger TX
R Jeb Hensarling TX
R Will Hurd TX
R Sam Johnson TX
R Michael McCaul TX
R Randy Neugebauer TX
R Pete Olson TX
D Beto O’Rourke TX
R Ted Poe TX
R John Ratcliffe TX
R Pete Sessions TX
R Lamar Smith TX
R Mac Thornberry TX
R Randy Weber TX
R Roger Williams TX
R Rob Bishop UT
R Jason Chaffetz UT
R Mia Love UT
R Chris Stewart UT
R David Brat VA
R Barbara Comstock VA
R J. Forbes VA
R Bob Goodlatte VA
R H. Griffith VA
R Robert Hurt VA
R Edward Rigell VA
R Robert Wittman VA
R J. Herrera Beutler WA
R C. McMorris Rodgers WA
R Dan Newhouse WA
R David Reichert WA
R Sean Duffy WI
R Glenn Grothman WI
R Reid Ribble WI
R Paul Ryan WI
R F. Sensenbrenner WI
R Evan Jenkins WV
R David McKinley WV
R Alex Mooney WV
R Cynthia Lummis WY
No (154)
Our pick
D Terri Sewell AL
D Ruben Gallego AZ
D Pete Aguilar CA
D Karen Bass CA
D Xavier Becerra CA
D Ami Bera CA
D Julia Brownley CA
D Lois Capps CA
D Tony Cárdenas CA
D Jim Costa CA
D Susan Davis CA
D Mark DeSaulnier CA
D Anna Eshoo CA
D Sam Farr CA
D John Garamendi CA
D Janice Hahn CA
D Michael Honda CA
D Barbara Lee CA
D Ted Lieu CA
D Alan Lowenthal CA
D Doris Matsui CA
D Jerry McNerney CA
D Nancy Pelosi CA
D Scott Peters CA
D Raul Ruiz CA
D Linda Sánchez CA
D Adam Schiff CA
D Brad Sherman CA
D Jackie Speier CA
D Eric Swalwell CA
D Mark Takano CA
D Mike Thompson CA
D Norma Torres CA
D Juan Vargas CA
D Diana DeGette CO
D Ed Perlmutter CO
D Jared Polis CO
D Rosa DeLauro CT
D Elizabeth Esty CT
D James Himes CT
D John Larson CT
D John Carney DE
D Kathy Castor FL
D Theodore Deutch FL
D Lois Frankel FL
D Alcee Hastings FL
D Patrick Murphy FL
D D. Wasserman Schultz FL
D Sanford Bishop GA
D Henry Johnson GA
D John Lewis GA
D Mark Takai HI
D David Loebsack IA
D Cheri Bustos IL
D Danny Davis IL
D Tammy Duckworth IL
D Robin Kelly IL
D Daniel Lipinski IL
D Mike Quigley IL
D Bobby Rush IL
D Janice Schakowsky IL
D André Carson IN
D Peter Visclosky IN
D John Yarmuth KY
D Cedric Richmond LA
D Katherine Clark MA
D William Keating MA
D Joseph Kennedy MA
D Stephen Lynch MA
D James McGovern MA
D Seth Moulton MA
D Niki Tsongas MA
D Elijah Cummings MD
D John Delaney MD
D Donna Edwards MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Chellie Pingree ME
D John Conyers MI
D Debbie Dingell MI
D Daniel Kildee MI
D Brenda Lawrence MI
D Sander Levin MI
D Keith Ellison MN
D Betty McCollum MN
D Richard Nolan MN
D Timothy Walz MN
D Wm. Clay MO
D Emanuel Cleaver MO
D Bennie Thompson MS
D Alma Adams NC
D George Butterfield NC
D David Price NC
D Ann Kuster NH
D Donald Norcross NJ
D Frank Pallone NJ
D Bill Pascrell NJ
D Albio Sires NJ
D B. Watson Coleman NJ
D Ben Luján NM
D M. Lujan Grisham NM
D Yvette Clarke NY
D Joseph Crowley NY
D Brian Higgins NY
D Steve Israel NY
D Nita Lowey NY
D Carolyn Maloney NY
D Gregory Meeks NY
D Jerrold Nadler NY
D Charles Rangel NY
D Kathleen Rice NY
D José Serrano NY
D Louise Slaughter NY
D Paul Tonko NY
D Nydia Velázquez NY
D Joyce Beatty OH
D Marcia Fudge OH
D Marcy Kaptur OH
D Tim Ryan OH
D Earl Blumenauer OR
D Suzanne Bonamici OR
D Peter DeFazio OR
D Kurt Schrader OR
D Brendan Boyle PA
D Robert Brady PA
D Matthew Cartwright PA
D Michael Doyle PA
D Chaka Fattah PA
D David Cicilline RI
D James Langevin RI
D Steve Cohen TN
D Jim Cooper TN
D Henry Cuellar TX
D Lloyd Doggett TX
D Al Green TX
D Gene Green TX
D Rubén Hinojosa TX
D Eddie Johnson TX
D Marc Veasey TX
D Donald Beyer VA
D Gerald Connolly VA
D Robert Scott VA
D Peter Welch VT
D Suzan DelBene WA
D Denny Heck WA
D Derek Kilmer WA
D Rick Larsen WA
D Jim McDermott WA
D Adam Smith WA
D Ron Kind WI
D Gwen Moore WI
D Mark Pocan WI
Not Voting (35)
R Robert Aderholt AL
D Raúl Grijalva AZ
D Ann Kirkpatrick AZ
D Judy Chu CA
R Paul Cook CA
D Jared Huffman CA
D Zoe Lofgren CA
D Grace Napolitano CA
R Dana Rohrabacher CA
D L. Roybal-Allard CA
D Loretta Sanchez CA
D Maxine Waters CA
D Joe Courtney CT
D Corrine Brown FL
R Ron DeSantis FL
D Alan Grayson FL
D Frederica Wilson FL
R Lynn Westmoreland GA
D Luis Gutiérrez IL
R Ann Wagner MO
R Trent Kelly MS
D Donald Payne NJ
D Dina Titus NV
D Eliot Engel NY
D Hakeem Jeffries NY
D Grace Meng NY
R Steve Russell OK
R Tom Marino PA
D James Clyburn SC
R Stephen Fincher TN
R John Carter TX
D Joaquin Castro TX
D Sheila Jackson Lee TX
R Kenny Marchant TX
D Filemon Vela TX