One of vice presidential candidate Paul Ryan’s favorite criticisms of the Affordable Care Act is that the Independent Payment Advisory Board (IPAB) — a 15-panel board that recommends ways to reduce Medicare costs — would “ration” health care for seniors. But in 2009, Ryan proposed two cost-control advisory boards in his Patients’ Choice Act that were remarkably similar to the Obamacare provision.
The ACA explicitly prohibits the IPAB from cutting benefits and the board would only develop a plan to lower costs only if health care spending exceeds a set threshold. Ryan’s boards are more severe and would have gone further to lower provider reimbursement rates by including penalties for physicians who don’t follow guidelines.
ThinkProgress compared the two plans:
|Board Structure||Commission–5 members appointed by the President subject to Senate approval. No commissioner may engage in any other business, vocation, or employment; Forum–15 members chosen by the Commission||15 members appointed by the President subject to Senate approval. No member may engage in any other business, vocation, or employment.|
|Operative Element||“The development and periodic review and updating of standards of quality, performance measures, and medical review criteria”||Offer recommendations as to how to cut back on Medicare spending costs|
|Scope of Authority||Entire health-care system; commissioners will select specific targets.||Medicare|
|Recommendation Frequency||Recommendations must be made once a year||Recommendations are only made when the Medicare’s per capita expense exceeds its growth targets|
|Source of Enforcement Authority||Commission works directly with the Secretary of Health and Human Services without congressional oversight.||IPAB’s recommendations must be approved by Congress.|
|Guideline enforcement||Exclude providers from federal health care programs or impose civil fines||Impose cuts in health providers’ reimbursement benefits|
Former ThinkProgress intern Sarah Bufkin contributed to this post.