TABLE: Ryan’s 2009 Health Plan Included Two IPAB-Like Boards

Rep. Paul Ryan is disputing claims that two independent advisory boards he introduced as part of his Patients’ Care Act (PCA) mirror the Affordable Care Act’s Independent Payment Advisory Board — a 15-member panel that he argues would “ration” health care. Responding to a blog post by the Incidental Economist’s Don Taylor that highlighted the similarities between Ryan’s boards and the IPAB, Conor Sweeney — the House Budget Committee’s Communications Director — sent Taylor a letter defending its chairman:

-The PCA empowers beneficiaries whereas the ACA enmpowers IPAB — “an unconstitutional board.”

-The ACA IPAB will “impose price controls, cut provider reimbursements, or make coverage determinations by fiat,” but the PCA’s Health Services Commission “exists solely for the purpose of encouraging transparency and proper metrics with respect to health care services.”

-IPAB will control Medicare costs by cutting provider reimbursements, “denying care for seniors.” Ryan’s Health Services Commission has “no authority to influence Medicare spending.”

But Ryan’s “differences” don’t mask the striking similarities between IPAB and the two boards proposed under the PCA — the Health Services Commission and the Forum for the Quality and Effectiveness in Health Care. In fact, in many ways, the PCA’s boards are more intrusive and hit providers harder. Read the pages 206–215 of the PCA Act here. ThinkProgress has also assembled a chart to illustrate:


PCAACABoard StructureCommission — 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 Commission15 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 costsScope of AuthorityEntire health-care system; commissioners will select specific targets.MedicareRecommendation FrequencyRecommendations must be made once a yearRecommendations are only made when the Medicare’s per capita expense exceeds its growth targetsSource of Enforcement AuthorityCommission works directly with the Secretary of Health and Human Services without congressional oversight.IPAB’s recommendations must be approved by Congress. Guideline enforcementExclude providers from federal health care programs or impose civil finesImpose cuts in health providers’ reimbursement benefits

-Sarah Bufkin