Tuesday, July 12, 2011

Questions for Secretary Sebelius on IPAB

Today begins a double-header of IPAB-related hearings in the House; Secretary Sebelius will be testifying before the House Budget Committee this morning, and before the Energy and Commerce Committee tomorrow morning.  In advance of these hearings, we’ve prepared a list of possible questions surrounding IPAB – Obamacare’s board of unelected bureaucrats – that the Secretary’s testimony may help resolve:

Fiscal Impact

  1. Both the Congressional Budget Office and the Medicare trustees agree that the Medicare program is running permanent deficits and will never come into balance absent reform.  Given this dire fiscal situation, exactly how long will IPAB extend the solvency of the Medicare program?


  1. You recently wrote in a Politico op-ed that “contrary to critics’ contentions, the board’s work will be transparent, independent, and accountable to Congress and the President.”  Where in the statute is the requirement that IPAB’s bureaucrats conduct a public process, and solicit public comment, prior to issuing its recommendations?  Put another way, is there anything prohibiting IPAB members from negotiating backroom deals regarding their recommendations, similar to the “rock-solid deal” the Administration struck behind closed doors with Big Pharma?
  2. In May the Administration proposed requiring state Medicaid programs to obtain public comments before reducing provider reimbursement levels.  Why is the Obama Administration imposing public comment requirements on state Medicaid programs, but not imposing a similar requirement on its controversial IPAB?


  1. Your Politico op-ed notes that “economists” will comprise some of the “health experts” appointed to IPAB.  Why do you believe economists are qualified to pass judgment on health care treatments?
  2. According to the statute, a majority of IPAB members must not be “individuals who are directly involved in the provision” of health care services.  Do you believe it’s appropriate that a majority of IPAB’s members must be bureaucrats rather than doctors and nurses who treat patients firsthand?
  3. Why hasn’t the President nominated his appointees to IPAB yet?  The statute gives the board $15 million in mandatory funding, beginning in October.  If the President believes IPAB is such a good thing, why hasn’t he nominated members promptly, so the board can be up and running in short order?


  1. You have claimed that IPAB “is expressly prohibited from making recommendations that ration care.”  Where exactly in the statute is the term “rationing” defined?
  2. Where in the statute is there a prohibition on IPAB making recommendations that could reduce access to breast cancer treatments – say, mammograms?  What about diabetes treatment and prostate cancer screenings – are there any provisions in the law that explicitly state IPAB cannot reduce access to those treatments?
  3. Last week the New York Times editorial board wrote that “A prime driver of our escalating health care costs is the advance of medical technology and the understandable desire of patients and doctors to adopt the latest treatment.  Sooner or later, as the nation struggles to contain health care spending, we may need to devise measures to determine whether very high-priced drugs provide enough medical benefit to warrant paying the bill.”  Do you agree?

Judicial Review

  1. If someone believes that IPAB has in fact rationed care, what redress does that person have to challenge the board’s decisions, seeing as how the board’s recommendations are exempt from judicial or administrative review?
  2. For nine years you served as Executive Director of the Kansas Association of Trial Lawyers, whose mission statement is “to uphold and advocate for the right of the individual for redress of grievances and access to the courts.”  How is your support for IPAB – which blocks access to the courts for any beneficiaries harmed by the board’s recommendations – consistent with the mission statement of the organization you headed for nearly a decade?
  3. In 2009 President Obama stated that he was “not advocating caps on malpractice awards…which I personally believe can be unfair to people who’ve been wrongfully harmed.”  If that’s still the President’s position, why does IPAB cap damages for people wrongfully harmed at ZERO – by never allowing them to file legal action at all?
  4. If the IPAB will not harm seniors and Medicare beneficiaries, why does the statute prohibit lawsuits against its recommendations in the first place?
  5. Would the Administration support repealing the provision prohibiting judicial review of IPAB’s recommendations?  Why or why not?

Other “Expert” Recommendations

  1. Your Administration has defended the IPAB on the grounds that independent experts should be called upon to make recommendations “to help Medicare provide better care at lower costs.”  The Medicare Payment Advisory Commission – a panel of experts similar to IPAB – recently came out in support of requiring co-pays for home health visits, on the grounds that a modest co-pay would encourage appropriate use of home health care.  Does the Administration agree with the recommendations of the MedPAC “experts?”
  2. Likewise, the President’s own Fiscal Commission supported restructuring Medigap insurance to “constrain over-utilization and reduce overall spending.”  Does the Administration agree with this recommendation of the “expert” panel the President himself appointed?

Broader Applicability

  1. Do you believe Members of Congress should follow, and/or be subject to, IPAB’s recommendations?  Will you do so yourself?
  2. Do you believe IPAB supporters who claim to support “experts” making health care choices should use their own independent resources to buy out of a rationing regime if IPAB restricts access to needed services and treatments?
  3. Does the Administration plan on running ads featuring Andy Griffith informing Medicare beneficiaries that their health care will be determined in part on the recommendations of a board of unelected bureaucrats?  If not, why not?

House Republican Budget

  1. You recently received Three Pinocchios from the Washington Post for making “outrageous” assertions and “ present[ing] a highly inflammable comment as a statement of fact” about the House-passed budget, comments for which the Post said you “should be ashamed.”  Do you agree with the Post’s characterization of your allegation that “there’s no question” patients would “die sooner” under the House-passed budget?  If not, why not?  Do you still stand by your original comments?
  2. You’ve previously testified before Congress that you have in fact read all of Obamacare.  Therefore, can you please explain the language on page 111 of the statute regarding the inflation adjustment mechanism for Obamacare premium subsidies in the years after 2018, and explain how exactly this inflation adjustment mechanism differs from the inflation adjustment mechanism for Medicare premium support payments included in the House-passed budget, which you said would cause seniors to “die sooner?”