Wednesday, March 28, 2012

AFFORDABLE CARE ACT AND THE IPAB: whose sails should be trimmed?

THE INDEPENDENT PAYMENT ADVISORY BOARD (IPAB) of the Affordable Care Act (ACA) was written into the ACA to control costs. It is a regulatory mechanism included in the ACA to regulate the commerce that the ACA creates. Congress cannot reasonably argue that the ACA doesn't create commerce while at the same time inserting into the ACA a mechanism to regulate newly created commerce. The argument comes down to this point: either Congress has the right to create commerce or it does not.

As a regulatory mechanism, the IPAB will have the authority to deny access to care to methods of diagnosis and treatment prescribed by licensed physicians. The IPAB will not report to Congress nor to the population at large. As a politically appointed board the IPAB will report to the political persons who appointed them.

The Supreme Court of the United States (SCOTUS) could invalidate some but not all parts of the ACA which was characterized in court as consisting of over 2,000 pages which many members of Congress haven't read and don't understand. On the other hand, everyone understands that insurance companies, left to their own devices, have often arbitrarily denied forms of treatment or engaged in retroactive denials of care and coverage. Nobody trusts the insurance companies to do the right thing, least of all Congress which exempted itself from the ACA. A modest proposal would be to preclude retroactive denials of coverage and arbitrary utilization review by doctors who haven't interviewed and examined the patients for whom specific diagnostic and treatment protocols have been prescribed. Another modest proposal would be to repeal the IPAB.

The more radical proposals are to do away with the entire ACA which would strip away protection from denials of care based on pre-existing conditions, e.g., life, and which could also pave the way for wrongful denials of care especially to the poor and elederly and to Medicaid and Medicare in particular.

Both sides have in common a distrust of the insurance companies; however, the Justices are supposed to deal with issues of law, not justice. It is strange then, isn't it, that we already know how at least four of the justices will rule. We don't need law degrees to know that. Neither do the justices need medical degrees to know the consequences of their decisions about the accessibility of medical care.


See The Weinmann Report on POLITICO Forums,, 3/28/2012, Reply # 43, ...

No comments:

Post a Comment