IPAB's structure and mandate
The IPAB is a 15-member board that would be tasked with controlling per capita spending on Medicare under healthcare reform. Board members are appointed by the president and, subject to Senate confirmation, and are responsible for recommending cost-cutting measures or reforms if Medicare spending exceeds predetermined limits.
Under provisions of the ACA, Medicare's top actuary is required to conduct an annual study of Medicare growth and measure it against the economy as a whole.
IPAB members are only required to make a recommendation for reforms or payment cuts when Medicare actuaries conclude that the program is growing a full percentage point faster than the rest of the economy.
Under its current schedule, IPAB would not hold its first meeting until 2014 and would not make its first recommendation until 2015, and then only if Medicare spending rates were to trigger action by the board.
IPAB supporters suggest that opponents of the board are primarily Republicans who oppose federal healthcare reform and are looking for new ways to vilify it, having already classified IPAB as a "death panel" for senior citizens.
"I don't see any merit to Republican criticism of IPAB," said Jerry Kominski, a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health.
"The board is independent and is charged with developing and implementing policies for reducing Medicare expenditures if those expenditures are growing faster than targeted rates." He added that the "mission of IPAB is so constrained by the ACA that the only real option available is to propose eliminating coverage for ineffective healthcare services or treatments."
During a 2012 Senate hearing regarding IPAB, Sen. Jay Rockefeller (D-WV) told physicians that "lawmakers are the worst possible group to determine how you get reimbursed" and that physicians and patients would be better served by an independent board rather than a congressional committee.