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The Affordable Care Act, the health care reform law known commonly as Obamacare, remains a hot button subject in political campaigns.
Not surprisingly, many claims made about the law in the 2010 campaign season are circulating again. Several appear in a brochure the Ohio Republican Party sent to voters in support of Mitt Romney's presidential campaign.
The brochure is aimed specifically at seniors. It says they can count on Romney, but not on President Obama, who "has worked to change Medicare for the worse."
One of the ways Obama has done that, the mailing says, is by "creating an unelected, unaccountable panel with the power to deny coverage of certain treatments."
That statement echoed several similar claims PolitiFact has checked about the health care law and the unelected Independent Payments Advisory Board, or IPAB for short.
For this fact-check, we will borrow from our previous items to explain the board and the brochure's claim. Some of our information comes from the Kaiser Family Foundation, a nonprofit, nonpartisan group that studies health care, which put out a primer in 2010 about the board and a longer paper in 2011.
Just what is IPAB?
The board was created by the 2010 health care law in response to criticism that Congress has been unwilling or unable to slow the increasing costs of Medicare, the federal program that pays for seniors’ health care.
Under the health care reform law, if Medicare spending growth is projected to exceed pre-set targets, the IPAB must come up with plans to slow that increase. If Congress does not act on the recommendations within a set time, IPAB’s recommendations automatically go into effect. (For a more detailed explanation of how this would work, we recommend this April 2011 report from the independent Kaiser Family Foundation.)
The IPAB can reduce how much the government pays health care providers for services, reduce payments to hospitals with very high rates of readmissions, or recommend innovations that cut wasteful spending. Some argue that because the IPAB can reduce what the government pays health care providers, its decisions could ultimately impact what services are available to patients.
But IPAB recommendations themselves would not apply to any particular individual.
Rather, they would be across-the-board policy recommendations applied to the entire program. Given the claim's wording that IPAB could "deny coverage of certain treatments," some readers could get the wrong impression that the board would review individual patient treatments and deny care. That’s not the case.
Still, the IPAB has become one of the more contentious points of the health care law; even some members of Congress who voted for the overall health care law don’t like the IPAB. Congress held hearings earlier this year on repealing the board.
The hearings were organized by opponents of the IPAB, but people who testified raised concerns that IPAB’s powers are so limited that its only real recourse is to reduce payments for doctors and other health care providers, which could end up putting pressure on patient care.
We should note that these concerns are also present under the current system, in which Congress takes a more active role.
Limits on its powers
There are restrictions on what IPAB can recommend in the name of cost savings. It cannot raise rates, reduce benefits, drop beneficiaries or ration care. Here’s the exact language from the law itself:
"The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."
The brochure calls the IPAB an "unelected, unaccountable panel." Its 15 full-time members aren’t elected. But that doesn’t mean they’re unaccountable.
• They’re appointed by the president and approved by the Senate.
• They can’t serve more than two six-year terms.
• Their recommendations can be rejected by Congress.
• They must follow disclosure and ethics guidelines, and they can’t perform other jobs as they serve.
• They can be removed by the president for "neglect of duty" or "malfeasance in office," though not for any other reason.
In addition to limiting the reasons a board member might be removed, lawmakers sought to insulate the board’s decisions from special-interest lobbying:
Its recommendations are fast-tracked in Congress and go into effect automatically if lawmakers fail to act. Implementation of its recommendations isn’t subject to administrative or judicial review.
So while their decisions are protected by law, board members are to some degree accountable. In particular, they could fail to win a second term, or get fired by the president.
The mailing by the Ohio Republican Party said "President Obama is weakening Medicare as we know it" by "creating an unelected, unaccountable panel with the power to deny coverage of certain treatments."
There’s an small element of truth in the claim. Board members aren’t elected. And the board will make decisions that arguably could impact the availability of services.
But it’s a stretch to say the members of the board are entirely unaccountable. They’re appointed by the president and approved by the Senate. The president can fire them for neglect of duty or malfeasance.They’re required to recommend cuts to Medicare in years that other cost-saving measures don’t meet growth targets — but Congress can overrule their recommendations.
And describing the board as having "the power to deny coverage of certain treatments" could lead readers to believe the board will sit around a table and talk about individual cases, like whether grandpa can get his bypass or not, and that’s not the case. The board won’t look at individual patients or deny individual treatments. Instead, it will make system-wide recommendations to rein in the future growth of Medicare spending, and it makes those recommendations within limited parameters.
Those are critical facts that would give a different impression.
On the Truth-O-Meter, the claim in the GOP mailer rates Mostly False.
Ohio Republican Party, "Ohio Seniors" brochure, September 2012
PolitiFact, "Gingrey claims federal health care board can decide if you get dialysis, chemo," Aug. 2, 2011
PolitiFact, "Pat Boone says IPAB rations care to pay for 'wasteful' spending," March 15, 2012
PolitiFact, "Paul Ryan said '15 unelected, unaccountable bureaucrats' could 'lead to denied care for current seniors’," Aug. 23, 2012
PolitiFact, "Romney says IPAB board can 'tell people ultimately what treatments they're going to receive,'" Oct 4, 2012
Kaiser Family Foundation, "The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending," April 2011
Government Printing Office, The Patient Protection and Affordable Care Act, March 23, 2010
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