In an acrimonious appearance before the House Budget Committee Sebelius drew sharp contrasts between the Republican plan for Medicare and the IPAB. "The Independent Patient Advisory Board makes recommendations to Congress," she said. "It is forbidden by law to do exactly what the Republican budget plan does. It may not shift costs to seniors and it may not change benefits."
Committee Chairman Paul Ryan (R-WI), the chief architect of the Republican budget plan, which is often referred to as the Ryan plan, pressed Sebelius to explain how unilateral decision making by "this board of 15 unelected officials whose decisions can only be overturned by a supermajority in Congress" could possibly be the best way control healthcare costs.
Noting IPAB's initial $15 million budget Ryan said, "I just don't think we should invest all of this money and power in the decisions of 15 people versus giving beneficiaries a choice of how they want to spend their healthcare dollars."
Sebelius responded that the Republican plan to provide premium support to Medicare beneficiaries "is nothing but cost-shifting that has no plan for the delivery of healthcare and doesn't save a penny."
Republicans on both committees expressed concerns about the composition of the IPAB. Sebelius explained that the members will be appointed by the president with confirmation by the Senate. Their salaries will be about $165,000 annually. President Obama hasn't nominated any members yet, but Sebelius said she expects the IPAB to be active by 2014 as required by the ACA.