Providers Renew Bid to Repeal IPAB In Light Of SCOTUS' ACA Decision

Posted: July 3, 2012

Health care stakeholders, including key physician and pharmaceutical industry groups, are renewing their bid to repeal the health reform law's Independent Payment Advisory Board in the wake of the Supreme Court's decision Thursday to uphold the majority of the law. In the hours after the high court ruled, stakeholders vowed to work with both Democratic and Republican lawmakers to repeal IBAP and fine tune the law before it is fully implemented in 2014.

The Healthcare Leadership Council said Thursday that in spite of the court's decision, "we shouldn't lose sight of the fact … that the need to continue improving the quality and affordability of our healthcare system remains strong," and added that Congress must still address aspects of the Affordable Care Act that could undermine affordability, access, quality and innovation, including the IPAB. The controversial board is required by the health care law to recommend ways to reduce Medicare spending in years when the projected growth rate in costs exceeds specific thresholds.

HLC President Mary Grealy told Inside Health Policy that IPAB is not the right way to get better value out of the health care system or to cut costs. Grealy said there is unanimity in the health care world that IPAB should be repealed, and the American Association of Orthopedic Surgeons and the Biotechnology Industry Organization said that in the wake of the ACA decision they will continue to support efforts to repeal the IPAB provision. The Pharmaceutical Research and Manufacturers of America also said the repeal of IPAB was one of the "necessary changes to the Affordable Care Act" that the group would continue to seek going forward.

Because it works on a yearly basis, the board has a short timeframe to take action, Grealy said, leaving cuts to providers as likely their only option to reduce Medicare spending. Grealy also complained that there is no method for judicial review of the IPAB's decisions. AAOS President John Tongue also said the year-to-year focus of the board would make it difficult to look at long-term payment reforms or any reforms that cannot be easily scored by the Congressional Budget Office.

"We cannot overlook provisions like the Independent Payment Advisory Board that threaten the doctor-patient relationship," Tongue said in a statement. He told Inside Health Policy that the AAOS will continue to push for the board's repeal, a move also supported by the American Medical Association, because the group believes any cuts the board would decide to implement would fall disproportionately on providers like orthopedists.

The House voted to repeal the IPAB in March, but the Senate has not taken up the bill. Grealy and the AAOS agreed that any further action to repeal IBAP would not be occur until after the election, and said it has a chance of moving forward after November depending on the outcome of the elections. Tongue said that in his experience "you continue to push for the ideas that you really are concerned about, and you never know when a window may be open."

Stakeholders also pledged to work on a myriad of other tweaks to the law in the coming months. AdvaMed is pushing Senators to follow the House's lead and repeal the medical device tax, and said the group is heartened by the number of senators who have said they would support such a repeal. The HLC also plans to push for a repeal of the device tax, and said the tax will place obstacles in the way of lifesaving innovations getting to patients. The tax will also, according to the HLC, cause the sector to shed jobs.

Both the National Community Pharmacists Association and the National Association of Chain Drug Stores said they will continue to prioritize Medication Therapy Management moving forward with health care reform. The NCPA also said that implementation of the ACA's provisions to achieve reasonable reimbursement for Medicaid generic prescriptions have been disappointing so far. -- Michelle M. Stein