.
The Independent Payment Advisory Board
(IPAB): Frequently Asked Questions
Jim Hahn
Specialist in Health Care Financing
Christopher M. Davis
Analyst on Congress and the Legislative Process
Edward C. Liu
Legislative Attorney
June 16, 2015
Congressional Research Service
7-5700
www.crs.gov
R44075
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The Independent Payment Advisory Board (IPAB): Frequently Asked Questions
Summary
This report responds to frequently asked questions about the Independent Payment Advisory
Board (IPAB), including the board’s background, current status, controversial issues including
legal challenges, and recent legislative efforts to repeal the IPAB.
For additional information, see CRS Report R41511, The Independent Payment Advisory Board,
by Jim Hahn and Christopher M. Davis.
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Contents
Frequently Asked Questions ...................................................................................................... 1
What Is the Independent Payment Advisory Board? ........................................................... 1
Why Was the IPAB Created? ............................................................................................... 1
Why Is the IPAB Controversial? ......................................................................................... 2
What Triggers IPAB Action? ............................................................................................... 2
Who Are the Members of the IPAB, and How Are They Appointed? ................................. 3
Why Hasn’t the IPAB Been Constituted? Why Haven’t Any Members
Been Appointed? .............................................................................................................. 4
What Are the Fast-Track Procedures That IPAB Legislation Would
Receive in Congress? ....................................................................................................... 4
Are There Fast-Track Procedures for Legislation Discontinuing IPAB? ............................ 5
What Internal Congressional Rules Have Been Adopted Addressing the IPAB? ............... 6
Are the House and Senate Required to Follow the Fast-Track Procedures
in the Act? ........................................................................................................................ 6
What Restrictions Did the ACA Place on Congressional Consideration of
IPAB Legislation? ............................................................................................................ 7
What If the IPAB Fails to Submit a Required Proposal? .................................................... 7
What Legal Challenges Have Been Raised Regarding the IPAB, and What Is the
Status of the Lawsuits? ..................................................................................................... 8
What Recent Legislative Activity Related to the IPAB Has There Been? .......................... 8
How Has CBO Scored IPAB-Related Bills? ..................................................................... 10
Tables
Table 1. Summary of IPAB-Related Bills ........................................................................................ 9
Contacts
Author Contact Information........................................................................................................... 11
Acknowledgments ......................................................................................................................... 11
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Frequently Asked Questions
What Is the Independent Payment Advisory Board?
Established as part of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as
amended), the Independent Payment Advisory Board (IPAB) is charged with developing
proposals to “reduce the per capita rate of growth in Medicare spending.”1 The board’s proposals
are to be implemented by the Secretary of Health and Human Services (the Secretary) unless
Congress acts either by formulating its own proposal to achieve the same savings or by
discontinuing the automatic implementation process defined in the statute.
Why Was the IPAB Created?
Given that historic patterns of growth in overall health care spending, and in the Medicare
program in particular, are viewed as not being sustainable,2 several proposals have been advanced
over the years to create an independent policymaking entity that would (1) be charged with
limiting the future growth in Medicare expenditures; (2) be insulated from special interests and
lobbyists because its members would be appointed, rather than elected; and (3) be comprised of
officials who would serve for extended terms. Such officials were envisioned to be able to make
“hard decisions” to control rising costs. Moreover, it has been assumed that these officials would
possess the specialized expertise needed to make operational decisions regarding payments and
focus initiatives on beneficiary interests and the longer-term financial viability of the program.
Prior proposals for similar entities include the following:
• In 2000 and 2001, Senators Breaux and Frist introduced reform proposals to
increase the budget of the Centers for Medicare and Medicaid Services (CMS),
create separate agencies to administer parts of the Medicare program, and
establish a Medicare board to manage competition among private plans and
traditional Medicare (referred to as “Breaux-Frist I,” S. 1895, and “Breaux-Frist
II,” S. 358).
• In 2008, Senator Daschle proposed the Federal Health Board, modeled after the
Federal Reserve Board, with broad authority over both private and public health
care programs, including benefit and coverage recommendations, regulation of
private insurance markets, and improvements in quality of care.3
• In July 2009, the President submitted a draft proposal to Congress titled the
Independent Medicare Advisory Council Act of 2009 (referred to as the IMAC
proposal), that would have established a five-member council to advise the
1 Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), §3403(b). For a discussion of the
Independent Payment Advisory Board (IPAB) and other new entities created pursuant to the ACA, see CRS Report
R41315, New Entities Created Pursuant to the Patient Protection and Affordable Care Act.
2 See, for instance, the 2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds, at http://www.cms.gov/Research-Statistics-Data-and-Systems/
Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2014.pdf, pages 71 and 237. (Hereinafter the 2014
Medicare Trustees’ Report.)
3 Tom Daschle, Scott S. Greenberger, and Jeanne M. Lambrew, Critical: What Can We Do About the Health-care
Crisis (St. Martin’s Press, 2008).
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President on Medicare payment rates for certain providers. While the council
would have had authority to recommend broader policy reforms, its authority
outside of Medicare payment policy would have been limited.
The stated goal of the IPAB, as specified in the enabling statute, is to reduce the per capita growth
in Medicare expenditures, not to reduce overall Medicare expenditures. The IPAB would achieve
this goal by developing proposals for the Secretary to implement that reduce the growth in
Medicare expenditures.
By statute, the IPAB’s proposals must (1) relate only to the Medicare program; (2) result in a net
reduction in total Medicare program expenditures at least equal to the savings target established
by the Chief Actuary; (3) not include any recommendation to ration care, raise revenues or
Medicare beneficiary premiums, increase cost sharing, restrict benefits, or alter eligibility; (4) not
reduce payments to providers or suppliers scheduled to receive a reduction in payment as the
result of certain productivity adjustments under ACA Section 3401;4 (5) include
recommendations to reduce Medicare payments under Parts C and/or D; and (6) include
recommendations with respect to administrative funding for the Secretary to carry out the board’s
recommendations. The IPAB’s proposals would receive special status, as described below,
including “fast-track” procedures for congressional consideration.
The Congressional Budget Office (CBO), in its cost estimate of the ACA prior to passage,
projected that the cumulative impact of the board’s recommendations from 2015 through 2019
would reduce total spending by $15.5 billion; during the same period, total Medicare
expenditures were projected to be $3.9 trillion with average spending per beneficiary increasing
from $13,374 in 2015 to $15,749 in 2019. These savings represent a reduction of about $60.00
per year per Medicare beneficiary over the 2015 through 2019 period.
Why Is the IPAB Controversial?
Since the ACA was enacted (and the IPAB authorized), there have been several challenges to the
mission, authority, and constitutionality of the IPAB. In particular, critics have noted the special
procedures that IPAB bills would receive and the board’s ability and powers to affect federal
health care programs specifically and the health care sector more broadly. Each of these concerns
is addressed in the questions below.
What Triggers IPAB Action?
Section 1899A of the Social Security Act (SSA) requires the Chief Actuary of CMS to determine
by April 30, 2013, and annually thereafter, whether the projected five-year average growth in per
capita Medicare program spending exceeds a specified target. For determination years through
2017, the target is equal to the average of the projected five-year average growth in the Consumer
Price Index for All Urban Consumers (all items; United States city average, or CPI-U) and the
medical care expenditure category of the CPI-U. Beginning in 2018 and in subsequent years, the
target growth rate will be the projected five-year average percentage increase in the nominal GDP
per capita plus one percentage point. The five years to be used for a given determination year
4 See Appendix C in CRS Report R41511, The Independent Payment Advisory Board, by Jim Hahn and Christopher M.
Davis.
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consist of the two prior years, the current year, and the two following years; thus, the growth rates
used in the determination will include both actual and projected rates.
If the Chief Actuary finds that the growth rate does not exceed the targeted growth rate, the
process for the year ends. If the Chief Actuary determines that the growth rate exceeds the target
growth rate for any determination year, the Chief Actuary is required to establish an applicable
savings target for the implementation year, two years following the determination year.5
Who Are the Members of the IPAB, and How Are They Appointed?
The board is to be composed of 15 members appointed by the President with the advice and
consent of the Senate for up to two consecutive six-year terms.6 As such, the members would be
officers of the United States under the appointments clause of the U.S. Constitution.7 The
Secretary, the Administrator of CMS, and the Administrator of the Health Resources and Services
Administration (HRSA) would be ex-officio nonvoting members. In selecting individuals for
nomination, the President is to consult with the majority and minority leadership of the Senate
and House of Representatives—each respectively, regarding the appointment of three members.
The chairperson is to be appointed by the President, with the advice and consent of the Senate,
from among the members of the board.
The appointed members of the board are to represent varied professional and geographic
backgrounds and possess recognized expertise in health finance and economics, actuarial science,
health facility management, health plans and integrated delivery systems, and reimbursement of
health facilities. The members are to be drawn from a wide range of backgrounds, including but
not limited to
• physicians (allopathic and osteopathic) and other health professionals, providers
of health services, and related fields;
• experts in the area of pharmaco-economics or prescription drug benefit programs;
• employers;
• third-party payers; and
• individuals skilled in the conduct and interpretation of biomedical health services
and health economics research who have expertise in outcomes and effectiveness
research and technology assessment.
Board members are to include representatives of consumers and the elderly. A majority of the
appointed members cannot be individuals directly involved in the provision or management of the
delivery of Medicare items and services. The appointments would be for full-time service and
members would be compensated at Executive Schedule rates.
5 For details, see CRS Report R41511, The Independent Payment Advisory Board, by Jim Hahn and Christopher M.
Davis.
6 See ACA §3403(g)(1).
7 See Department of Justice Memorandum entitled “Officers Of The United States Within The Meaning Of The
Appointments Clause” for a discussion of why board members can exercise the authority delegated to them under the
statute. http://www.justice.gov/olc/2007/appointmentsclausev10.pdf.
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Why Hasn’t the IPAB Been Constituted? Why Haven’t Any Members
Been Appointed?
In brief, the IPAB has yet to be constituted and no members have been nominated (let alone
confirmed) because the conditions that would trigger IPAB activity have yet to be met. The CMS
actuary’s IPAB determination website8 details the calculations that conclude that the Medicare per
capita target growth rate would not be exceeded in 2014 (for proposals that would be
implemented in 2016). In the July 28, 2014, IPAB determination (the most recent available), the
CMS actuary states the following:
The projected 5-year average growth in Medicare per capita spending is 0.43 percent, and the
5-year average growth target is 2.61 percent. Because the projected 5-year Medicare per
capita growth rate does not exceed the Medicare per capita target growth rate, there is no
applicable savings target for implementation year 2016 (determination year 2014).9
The 2014 Medicare Trustee’s Report10 shows additional figures used for IPAB determination and
states that “the first determination that the Medicare per capita growth rate exceeds the per capita
target growth rate is projected to be made in 2022.”
What Are the Fast-Track Procedures That IPAB Legislation Would
Receive in Congress?
The ACA establishes two sets of parliamentary procedures. The first set of procedures governs
congressional consideration of IPAB implementing legislation. The act establishes a second set of
fast-track procedures (discussed in detail in “Are There Fast-Track Procedures for Legislation
Discontinuing IPAB?,” below) governing the consideration in 2017 of a joint resolution
discontinuing the automatic IPAB implementation process.
The ACA requires the board (and, in cases in which the board does not act, the Secretary) to
submit its proposal to both Congress and the President. The proposal is to be accompanied by,
among other things, implementing legislation. The Secretary is required to automatically
implement the proposals contained in the IPAB legislation on August 15 of the year such a
proposal is submitted, unless
• prior to that date, legislation is enacted that includes the statement, “This Act
supersedes the recommendations of the Board contained in the proposal
submitted, in the year which includes the date of enactment of this Act, to
Congress under section 1899A of the Social Security Act,”11 or
8 Centers for Medicare & Medicaid Services, “IPAB Determination,” at http://www.cms.gov/Research-Statistics-Data-
and-Systems/Research/ActuarialStudies/IPAB-Determination.html.
9 http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/IPAB-2014-07-
28.pdf
10 For details, see Table V.B2 on page 194 of the 2014 Medicare Trustees’ Report at https://www.cms.gov/Research-
Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2014.pdf.
11 ACA §1899(e)(3)(A)(i).
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• in 2017, a joint resolution discontinuing the automatic IPAB implementation
process has been enacted.12
The act establishes special fast-track parliamentary procedures governing House and Senate
committee consideration, and Senate floor consideration, of legislation implementing the board’s
or Secretary’s proposal. These procedures differ from the parliamentary mechanisms the
chambers usually use to consider most legislation, and they are designed to ensure that Congress
can act promptly on the implementing legislation should it choose to do so. The ACA-established
procedures accomplish this goal by mandating the immediate introduction of the legislation in
Congress and by establishing strict deadlines for committee and Senate floor consideration, as
well as by placing certain limits on the amending process. The procedures established by the act
permit Congress to amend the IPAB-implementing legislation, but only in a manner that achieves
at least the same level of targeted reductions in Medicare spending growth as is contained in the
IPAB plan. The act bars Congress from changing the IPAB fiscal targets in any other legislation it
considers as well, and it establishes procedures whereby a supermajority vote is required in the
Senate to waive this requirement. In addition, the act’s procedures include expedited mechanisms
that are intended to facilitate the exchange of implementing legislation between the House and
Senate. Finally, the procedures also expedite Senate consideration of a veto message on IPAB
implementing legislation, which otherwise would be subject to extended debate.
Are There Fast-Track Procedures for Legislation Discontinuing IPAB?
As noted above, the ACA established a second fast-track parliamentary mechanism for
consideration of legislation discontinuing the automatic implementation process for the
recommendations of the IPAB.
Under the terms of the act, to qualify for consideration under fast-track procedures a joint
resolution discontinuing the process must meet several conditions. The resolution must
• be introduced in 2017 by not later than February 1 of that year.
• not have a preamble.13
• have the title, “Joint resolution approving the discontinuation of the process for
consideration and automatic implementation of the annual proposal of the
Independent Medicare Advisory Board under section 1899A of the Social
Security Act.”14
• have the sole text, “That Congress approves the discontinuation of the process for
consideration and automatic implementation of the annual proposal of the
Independent Medicare Advisory Board under section 1899A of the Social
Security Act.”15
12 Such a joint resolution and the procedures for its consideration are described later in this report in “Are There Fast-
Track Procedures for Legislation Discontinuing IPAB?”
13 A preamble is a series of “whereas” clauses at the beginning of a measure describing the reasons for and intent of the
legislation.
14 ACA §1899(f)(1)(C).
15 ACA §1899(f)(1)(D).
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Such a joint resolution may be introduced by any Member in either chamber. When introduced,
the joint resolution is referred to the Committees on Ways and Means and on Energy and
Commerce in the House, and to the Committee on Finance in the Senate.
In the Senate, if the Committee on Finance has not reported this joint resolution (or an identical
joint resolution) by the end of 20 days of continuous session after its introduction, the committee
may be discharged from its further consideration of the measure upon a petition signed by 30
Senators. A non-debatable motion to proceed is in order in the Senate and, if adopted, debate on
the joint resolution is limited to 10 hours. The act does not establish any special procedures for
House floor consideration of such a joint resolution.
As with the special procedures established for considering IPAB-implementing bills described
above, the act also establishes “hookup” procedures to facilitate the consideration in one chamber
of a joint resolution passed by the other. Such provisions are designed to ensure that the House
and Senate act on the same legislation.
What Internal Congressional Rules Have Been Adopted Addressing the IPAB?
On the opening day of both the 113th (January 3, 2013) and 114th (January 6, 2015) Congresses,
the House of Representatives agreed to H.Res. 5, adopting the standing rules of the House for the
113th Congress (2013-2014) and 114th Congress (2015-2016), respectively. Section 3(a) of H.Res.
5, identical in each Congress, included the following language: “Independent Payment Advisory
Board - Section 1899A(d) of the Social Security Act shall not apply in the One Hundred
[Thirteenth/Fourteenth] Congress.”16
A section-by-section analysis of H.Res. 5 created by the House Committee on Rules and inserted
in the Congressional Record in each case described the IPAB provision contained in Section 3(a)
of H.Res. 5 in the following way: “Subsection (a) eliminates provisions contained in the [Patient
Protection and] Affordable Care Act that limit the ability of the House to determine the method of
consideration for a recommendation from the Independent Payment Advisory Board or to repeal
the provision in its entirety.”17
As a result, the fast-track parliamentary procedures governing consideration of an IPAB proposal
were not in force in the House of Representatives in the 113th Congress, nor are they in force in
the 114th Congress. The procedural rules still apply, however, in the Senate.
Are the House and Senate Required to Follow the Fast-Track Procedures
in the Act?
The fast-track parliamentary procedures established by the act for the consideration of both types
of IPAB legislation (an implementing bill and a joint resolution discontinuing the IPAB process)
are considered to be rules of the respective houses of Congress even though they are in statute. As
such, Congress traditionally has viewed them as subject to change in the same manner and to the
same extent that any House or Senate rule can be altered by the Members of that chamber. In
other words, Congress is not required to amend or repeal the ACA to change the internal
16 Rules of the House, Congressional Record, daily edition, vol. 159, no. 1 (January 3, 2013), p. H7.
17 Rules of the House, Congressional Record, daily edition, vol. 161, no. 1 (January 6, 2015), p. H13.
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congressional procedures these procedures contain. The House or Senate can change the
procedures by unanimous consent, by suspension of the rules, or by special rule reported by the
House Committee on Rules and adopted by the House. As noted above, the House has done
precisely this in both the current and prior Congress, adopting a resolution on the opening day of
both Congresses taking the fast-track procedures out of force in the House.
What Restrictions Did the ACA Place on Congressional Consideration of
IPAB Legislation?
As noted above, the special parliamentary procedures established by the ACA attempt to bar the
House or Senate from considering any bill, resolution, amendment, or conference report pursuant
to the special fast-track procedures contained in the act or by any other legislative mechanism that
would repeal or change the recommendations of the IPAB if that change would fail to achieve the
same targeted reductions in Medicare spending growth achieved by the IPAB proposal. In other
words, the procedures propose to bar Congress from considering, in any legislation (not just the
IPAB implementing bill) changes to the board’s recommendations that fail to meet at least the
same fiscal targets as those advanced by IPAB. Because the act establishes procedural rules
related not just to congressional consideration of the IPAB implementing bill but also governing
the consideration of other legislation as well, it differs from most expedited procedure statutes
now in force.
The act attempts to entrench this limitation on congressional action by stating that the provision
can be waived in the Senate only by an affirmative vote of three-fifths of Senators chosen and
sworn (60 votes if there is no more than one vacancy), the same threshold required to invoke
cloture on most measures and matters. An appeal of a ruling on a point of order under this
provision carries the same supermajority vote threshold to overturn the ruling of the Senate’s
presiding officer.
Significant questions exist about the ability of these provisions to restrict House and Senate
legislative action.18
What If the IPAB Fails to Submit a Required Proposal?
Following the activation of the trigger for an IPAB proposal as described above and if, for
whatever reason, the IPAB were to fail to submit a proposal as required (e.g., if members are not
appointed and confirmed in a timely manner), under current law the Secretary is directed to
develop and implement proposals automatically unless Congress affirmatively acts to alter the
proposals or to discontinue the automatic implementation of such proposals.
18 For a more extensive discussion of these questions, see CRS Report R41511, The Independent Payment Advisory
Board, by Jim Hahn and Christopher M. Davis.
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What Legal Challenges Have Been Raised Regarding the IPAB, and What Is
the Status of the Lawsuits?
The constitutionality of the IPAB has been the subject of recent litigation. However, the Supreme
Court refused to review the dismissal of such a suit by the Ninth Circuit in March 2015,
effectively ending that litigation for the near future.
The challenge to the IPAB, in a case entitled Coons v. Lew, was brought by a physician who
feared that he would be injured by the IPAB, because it had authority to recommend the reduction
of Medicare reimbursement rates that would be implemented unless Congress acted to alter the
recommended reductions.19 The plaintiff further argued that the IPAB itself was unconstitutional
because it was an impermissible delegation of legislative authority by Congress.
The non-delegation doctrine limits Congress’s authority to delegate legislative authority to federal
agencies. In its modern form, the doctrine generally requires that a statutory delegation include an
“intelligible principle” to guide the agency’s use of the delegated authority.20 In challenging the
IPAB as a violation of the non-delegation doctrine, the plaintiffs argued that the provisions in
Section 1899A of the SSA do not provide a sufficiently “intelligible principle” that the IPAB
could use to guide its recommendations.
Without reaching the merits of the non-delegation claim, the Ninth Circuit dismissed the suit for
lack of jurisdiction. Specifically, the court determined that the suit was unripe because the
plaintiffs’ claimed harm from a future reduction in Medicare reimbursement rates was “wholly
contingent upon the occurrence of unforeseeable events.”21 Ripeness is a constitutional doctrine
that concerns whether it is appropriate for a court to resolve a particular dispute at the current
time. If a suit is unripe, federal court jurisdiction must be withheld until such time as “the
plaintiffs face a realistic danger of sustaining direct injury as a result of the statute’s operation or
enforcement.”22 Although the Ninth Circuit concluded that the plaintiffs had not met this
standard, these plaintiffs or others may be able to challenge the constitutionality of the IPAB in
the future, should conditions trigger the need for IPAB proposals that modify provider payments.
What Recent Legislative Activity Related to the IPAB Has There Been?
In addition to the opening day rules in the House of Representatives (see “What Internal
Congressional Rules Have Been Adopted Addressing the IPAB?”), two bills were introduced to
repeal the IPAB in the House and three in the Senate during the 113th Congress. To date, in the
114th Congress, one bill has been introduced to repeal the IPAB in the House of Representatives
and one in the Senate. (See Table 1.)
19 Coons v. Lew, 2014 U.S. App. LEXIS 17360 (9th Cir. Sept. 2, 2014) cert. denied, 135 S. Ct. 1699 (Mar. 30, 2015).
20 Panama Refining Co. v. Ryan, 293 U.S. 388 (1935); A.L.A. Schechter Poultry Corp. v. United States, 295 U.S. 495
(1935).
21 Coons v. Lew, 2014 U.S. App. LEXIS 17360.
22 Coons v. Lew, 2014 U.S. App. LEXIS 17360 (quoting Thomas v. Anchorage Equal Rights Comm’n, 220 F.3d 1134,
1138-9 (9th Cir. 2000)).
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Table 1. Summary of IPAB-Related Bills
(113th and 114th Congresses)
Bill Title
Summary
Lead
Sponsor
113th Congress
H.R. 37
Business and Government
“Amends the Internal Revenue Code and the
Rep. Barrow, John
Operations Improvement
Patient Protection and Affordable Care Act to
Act
repeal the employer and individual health
insurance mandates and the Independent
Payment Advisory Board.”
H.R. 351
Protecting Seniors’ Access
“Repeals sections of the Patient Protection and Rep. Roe, David P.
to Medicare Act of 2013
Affordable Care (PPACA) (and restores
provisions of law amended by such sections)
related to the establishment of an Independent
Payment Advisory Board to develop and
submit detailed proposals to reduce the per
capita rate of growth in Medicare spending to
the President for Congress to consider.”
S. 351
Protecting Seniors’ Access
“Repeals sections of the Patient Protection and Sen. Cornyn, John
to Medicare Act of 2013
Affordable Care (PPACA) (and restores
provisions of law amended by such sections)
related to the establishment of an Independent
Payment Advisory Board to develop and
submit detailed proposals to reduce the per
capita rate of growth in Medicare spending to
the President for Congress to consider.”
S. 1316
Protecting Seniors’ Access
“Repeals sections of the Patient Protection and Sen. Cornyn, John
to Medicare Act of 2013
Affordable Care (PPACA) (and restores
provisions of law amended by such sections)
related to the establishment of an Independent
Payment Advisory Board to develop and
submit detailed proposals to reduce the per
capita rate of growth in Medicare spending to
the President for Congress to consider.”
S. 2064
Four Rationers Repeal Act
“Repeals sections of the Patient Protection and Sen. Roberts, Pat
of 2014
Affordable Care (PPACA) (and restores
provisions of law amended by such sections)
related to the establishment of an Independent
Payment Advisory Board to develop and
submit detailed proposals to reduce the per
capita rate of growth in Medicare spending to
the President for Congress to consider.”
114th Congress
H.R. 1190
Protecting Seniors’ Access
“Repeals sections of the Patient Protection and Rep. Roe, David P.
to Medicare Act of 2015
Affordable Care Act (and restores provisions
of law amended by those sections) related to
the establishment of an Independent Payment
Advisory Board to develop proposals to
reduce the per capita rate of growth in
spending under title XVIII (Medicare) of the
Social Security Act.”
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Bill Title
Summary
Lead
Sponsor
S. 141
Protecting Seniors’ Access
“Repeals sections of the Patient Protection and Sen. Cornyn, John
to Medicare Act of 2015
Affordable Care Act (and restores provisions
of law amended by those sections) related to
the establishment of an Independent Payment
Advisory Board to develop proposals to
reduce the per capita rate of growth in
spending under title XVIII (Medicare) of the
Social Security Act.”
Source: Congressional Research Service.
Notes: In the 113th Congress, H.R. 351 and S. 351 were identical bills, while H.R. 1190 and S. 141 are identical
bills in the 114th Congress. Each summary is taken from the bill itself.
How Has CBO Scored IPAB-Related Bills?
To date, CBO has provided a cost estimate for just one of the bills from Table 1. On June 11,
2015, CBO released a score for H.R. 119023 as reported on June 2, 2015, by the House Ways and
Means Committee. CBO indicates that repealing the IPAB would increase direct spending in the
future; however, the estimate is subject to a high degree of uncertainty because of the unknown
likelihood that the IPAB authority would be triggered. Specifically, the cost estimate includes the
following summary:
CBO estimates that enacting H.R. 1190 would not have any budgetary impact between 2015
and 2021, but would increase direct spending by $7.1 billion over the 2022-2025 period.
That estimate is extremely uncertain because it is not clear whether the mechanism for
spending reductions under the IPAB authority will be triggered under current law for most of
the next ten years; under CBO’s current baseline projections such authority is projected to be
triggered in 2025. However, given the uncertainty that surrounds those projections, it is
possible that such authority would be triggered in more than one of those years; taking into
account that possibility, CBO estimates that repealing the IPAB provision of the ACA would
probably result in higher spending for the Medicare program in the years 2022 through 2025
than would occur under current law. CBO’s estimate represents the expected value of a broad
range of possible effects of repealing the provision over that period.
CBO also has noted that the IPAB could interact with provisions in other bills for which they
have provided cost estimates. For instance, the score for some bills that increase Medicare
spending by raising payments to Medicare providers includes an interaction with the IPAB
because of the increase in the likelihood that the trigger would be activated due to greater
Medicare program expenditures.24
23CBO, Cost Estimate: H.R. 1190: Protecting Seniors’ Access to Medicare Act of 2015, June 11, 2015, at
www.cbo.gov/sites/default/files/114th-congress-2015-2016/costestimate/hr1190.pdf.
24 See the CBO cost estimate for H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which became
P.L. 114-10, at http://www.cbo.gov/publication/50053.
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The Independent Payment Advisory Board (IPAB): Frequently Asked Questions
Author Contact Information
Jim Hahn
Edward C. Liu
Specialist in Health Care Financing
Legislative Attorney
jhahn@crs.loc.gov, 7-4914
eliu@crs.loc.gov, 7-9166
Christopher M. Davis
Analyst on Congress and the Legislative Process
cmdavis@crs.loc.gov, 7-0656
Acknowledgments
Michele Malloy contributed valuable assistance in the preparation of this report.
Congressional Research Service
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