Hal Scherz
America is anxiously awaiting the verdict on the Affordable Care Act (ACA, Obamacare) by the Supreme Court. This decision is still several months away, but during the hearings, the justices seemed to convey some disbelief that anyone could realistically look through this 2700 page law and make any sense out of it.
 
Most Americans are hopeful that the Supreme Court will overturn this law. In the event that it stands, or if just the mandate for individuals to purchase insurance is struck down, all of the other parts of the law will remain. So in spite of apparent optimism that Obamacare will be thrown out, we must not lose sight of the fact that there is a lot of potential badness heading our way.
 
Perhaps the worst of this law is exemplified by the Independent Payment Advisory Board (IPAB); one of the 159 new boards created by Obamacare.  IPAB consists of 15 individuals who are unelected- they will be appointed by the President and will be not be answerable to anyone.
 
They are tasked with a single objective- to reduce the per capita rate of growth of Medicare spending. IPAB will submit a proposal which will slash healthcare costs by determining what will be paid for and how much. The HHS Secretary is required to implement the proposal in its entirety, unless Congress acts to block them. However, Congress cannot act because the law prohibits the representatives from taking any action “that would repeal or otherwise change the recommendations of the Board,” unless it replaces the recommendations with its own legislation that would cut healthcare spending to the same target levels. So in essence, the recommendations of IPAB have the full effect of law. And the result will be to spend less on the healthcare of individuals.
 
Consider the hypocrisy on the part of President Obama when he threatens the Supreme Court and states that legislation which was passed by duly elected representatives should not be overturned by unelected judges, while fully aware that with the IPAB, power is taken away from elected members of Congress and given to the unelected bureaucrats of his choosing.  And even worse, President Obama believes that the ACA does not give IPAB enough power; he would like to see the scope of their authority expanded.
 
IPAB only has control over the reimbursement for medical services. This will affect only doctors until 2020, and then also hospitals thereafter. But do not be fooled into believing that it will affect only Medicare. Private healthcare spending will be reduced as well. IPAB has been given the power to reduce ALL healthcare expenditures, including private insurance. How might this occur? Once the state insurance exchanges are established, they will be under direct federal oversight and a variety of regulations will go into effect, including price controls. Additionally, private insurance rates follow Medicare rates in the market place, so actions by IPAB to reduce reimbursement will have an indirect effect on the private market.
 
The House of Representatives last month passed H.R. 5.–the PATH Act (Protecting Access to Healthcare). This bill calls for the repeal of IPAB. Unfortunately, despite bipartisan support, it is highly unlikely to pass in the Senate (if in fact Harry Reid even allows it to come up for a vote). Moreover, the passage of H.R.5 is merely symbolic. Those who crafted the ACA knew that this law was abhorrent and likely unconstitutional, so they needed to protect it from those who might attempt to dismantle it, and undo what progressives have worked for a century to accomplish. So they inserted something into the law like a “worm” on your computer- a measure that prevents you from deleting it.
 
In Section 3403, it is stated about IPAB that “it shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.” This section that Congress signed off on binds all future Congresses from altering it in any way.
 
The only possibilities that will spare us the wrath of IPAB would be if the Supreme Court agreed that the law is unconstitutional and threw out the entire law. But if that does not happen, then the only hope will be if there is a new President and a leadership change in the Senate, so that full repeal of the law can be enacted before any further damage is done to our healthcare system.

Hal Scherz

Dr. Hal Scherz is the Founder and President of Docs4Patient Care.