Tuesday, September 28, 2021
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Obamacare: Watching the IPAB Hearings

Health care costs currently consume 17% of our GDP, and 10.7% of the American workforce is employed in the healthcare industry.  Keep those facts in mind as you read this.

The hearings for IPAB are taking place this week, and we need to be watching the outcome of this.  Here’s the basic information needed to understand what the Independent Advisory Payment Board (IPAB) is all about….

What’s IPAB? A Beltway acronym for subverting the deliberative process.

The 15-member panel of government-appointed bureaucrats was slipped into Section 3403 of the Obamacare law against the objection of more than 100 House members on both sides of the aisle. IPAB’s experts would wield unprecedented authority over Medicare spending — and in time, over an expanding jurisdiction of private health care payment rates — behind closed doors.

Freed from the normal administrative rules process — public notice, public comment, public review — that governs every other federal commission in existence.

Without the possibility of judicial review.

And liberated from congressional oversight except through an onerous accountability procedure.

The Goldwater Institute in Arizona has filed a lawsuit challenging the constitutionality of IPAB.

“No possible reading of the Constitution supports the idea of an unelected, standalone federal board that’s untouchable by both Congress and the courts,” says the think tank’s litigation director, Clint Bolick.

The PPACA repeatedly refers to any IPAB proposal as a “legislative proposal” and speaks of “the legislation introduced” by the IPAB. Each proposal automatically becomes law unless Congress passes — with a three-fifths supermajority required in the Senate — a measure cutting medical spending as much as the IPAB proposal would.

 

This is a travesty of constitutional lawmaking: An executive branch agency makes laws unless Congress enacts legislation to achieve the executive agency’s aim.

 

And it gets worse. Any resolution to abolish the IPAB must pass both houses of Congress. And no such resolution can be introduced before 2017 or after Feb. 1, 2017, and must be enacted by Aug. 15 of that year. And if passed, it cannot take effect until 2020. Defenders of all this audaciously call it a “fast track” process for considering termination of IPAB. It is, however, transparently designed to permanently entrench IPAB — never mind the principle that one Congress cannot by statute bind another Congress from altering that statute.

There are a growing number of Democrats joining Republicans who are in support of repealing the IPAB provisions included in Obamacare, so we might actually see a true bipartisan effort to get this provision stricken from the law.

During the Congressional House hearings yesterday, DHHS Secretary Sebelius portrayed IPAB as being “a harmless “backstop mechanism” with limited powers to do anything at all to control costs” and “just another run-of-the-mill dog-and-pony panel that would be “irrelevant” if Congress so chooses”

Not for a single second am I inclined to put much confidence in Mdme. Secretary’s claims.  The developers of the law want IPAB left in the law in the hopes that they can expand on it later on.  They can claim that is “irrelevant” all they like, but that isn’t what they have in mind for IPAB to become…a means of usurping the authority of both the legislative and the judicial branch of government.

Please take note that IPAB will be given the power to control all payment rates, both public and private, for health care services.  Also note that the power IPAB has will extent into other aspects of Obamacare, including payment rates for those covered under the public health insurance exchange as well as Medicare and Medicaid.   If IPAB so chose, they could restrict payment rates for any type of health service, thereby causing rationing to take place under any type of health insurance.

In light of everything that is going on right now regarding the debt ceiling limit battle, it is the utmost of hypocrisy for Democrats, who were the ones primarily responsible for ensuring that excessive control mechanisms were incorporated into the Obamacare, to even try to at this point to paint Republicans as the villains.  They have their own plans to “gut” our health care system in place and have had such for over a year now.

13 COMMENTS

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13 COMMENTS

  1. I am curious so if someone can tell me the answer to this please do. It was my understanding that the reason Judge Vinson ruled this travesty unconstitutional is because of the individual mandate and the fact that there is NO SEVERABILITY in o-care. By nibbling around the edges, like removing the 1099 provisions and trying to remove this, will the boy prince and his minions then be able to make a de-facto case that these subsequent changes “granted” severability which would then allow most of this debacle to stand?

    • Suzanne, I’ll try to answer this. I think most of us as conservatives have set our minds on full repeal. And even though I personally would prefer full repeal, the course of action that DHHS has been taking of late alters the situation quite a bit.

      The left genuinely needs a second term in order to get a single-payer health care system up and running, and to have it become entrenched in American society. I’m guessing that they are at least acknowledging the reality that they may not get it. From their viewpoint, the best they can do is to move forward as quickly as they can toward a single-payer system, hoping that the elimination of their competition (i.e private health insurance providers) in the process will alter our traditional health insurance industry to the extent that what’s been done won’t be easily undone.

      Since just before the midterm election, implementation of Obamacare has been picking up speed. DHHS is now running ahead of schedule on implementation. The rulings that have been issued by DHHS lately have been more stringent than need be and have included short deadlines for compliance that make it difficult for private insurance companies to comply with the law.

      For those who have been watching the situation unfold, it looks like DHHS is “gunning” for their competition, no holds barred, consequences be [redacted]. Depending on how quickly things take place during the next 18 months, before the next President is sworn into office, we could lose some private health insurance providers. If this does take place, it is going to drive up health insurance costs for most businesses, and given the current state of economy, that’s a factor we would be better off without.

      And I think that’s the key point that some folks are looking at right now, taking all the factors into consideration.

      If we wait,we could find ourselves facing the reality that what’s been done won’t be easily undone, neither for the health insurance industry nor for businesses, not even by full repeal of the law.

      If we go on the offensive now, even if it is piecemeal, then we might at least have a chance to prevent certain types of damage from being done or alter the scope of damage that is done.

      I think that Obamacare could be repealed, line item by line item, if it came right down to it. Even if it was granted “severability”.

      • Thank you for that.
        I am not, nor would I ever be, a successful political animal… what with being the scorched earth kind of girl that I am and all. I have thus been nothing but disappointed in the House and it’s approach to its sworn full repeal of o-care. I fully expected them to attach an ammendment for its full repeal to every single bill requiring money… and MOST especially making it a condition for raising the debt ceiling. I expected them to make the little cretin veto every bill coming his way which had that as a condition… like on a weekly basis… so the American people could see first hand just exactly what the little {redacted}’s priorities are… all over the six o’clock news (or at least FOX) on a nightly basis. But nooooo. They held their symbolic little vote so they could say they tried and then Boehner used a rules trick to keep a repeal ammendment off a budget bill. Like Bachmann or not, she would have been throwing this at them on a weekly basis.
        And while I’m on this testy little pre-coffee rant this morning, the Tea Party in Ohio better come up with a viable candidate to primary Boehner by the end of this week… it might help his spine stiffen a bit. An KY 1 ought to start a recall petition on Mcconnell… like today.
        Thank you for your explanation and for all that all of you do!

        • Suzanne & lineholder:
          Excuse me for sticking my nose into your conversation here, but I absolutely agree. Our ‘leaders’, esp McConnell, have lost focus chasing this ‘make Obama a 1 term president’, which serves no useful purpose as articulated, just motivates the other side. What became of the battle-cry that the House controls the purse-strings, we can defund O-Care, and BTW, where are the awesome Issa investigations into the shenanigans Reid & Pelosi used to get the monster passed in the first place? Repeal, repeal, repeal attached to each & every item produced by the House, force the Senate to reject or stand pat, rinse & repeat for the next 18 months. Doesn’t seem to be happening.

          • I’m with you. Every damned bill every damned time. And what is truly tragic is that assorted state legislatures doing the redistricting in various states are re-drawing a lot of newly minnted Tea Party Conservatives out of their jobs (see the ever awesome Allen West) so it would appear to be a now-or-never time for us in the House.

            • Yep, and sadly some of the redistricting is being done by R’s not D’s. They hate them some Conservatives!

              McConnell honks me off–making Obama a 1 term president is a great tag-line for Sean Hannity, not so much for our ‘leader’ in the US Senate.

          • mriggio and Suzanne,

            Maybe I should have put a qualifier on a comment that I made earlier…the kind of attitude that DHHS has been displaying is “economic consequences be [redacted]”. Anyone who challenges them is likely to face retribution, Dems and Repubs alike, and it could very well come in the form of economic retribution at that. If it does, it will be we the people who suffer the most. I know, it’s a hard reality to accept, but I think this reality is part of why Repubs have been holding back. They need to see if any sort of break along party lines on the Dems side happens before they make serious challenges to the law.

            Here’s where it may backfire on the admin…if DHHS had taken a responsible approach to implementation of Obamacare, meaning that an objective review of the economic impact of policy implementation was being conducted in process with DHHS responding to that review in a manner that is genuinely in the best interest of our economy…Dems probably would have been content to stay within party lines.

            As time goes by and our economy isn’t improving, the fact that DHHS is continuing to take this type of approach becomes not only extremely irresponsible but also very dangerous economically as well.

            It appears that more Dems are beginning to look at this point realistically, and in doing so, they have to make a choice…do they continue to put party loyalty first or do they put what is best economically first, even if it means facing retribution. A few folks on the Dems side now seem to be at least willing to consider attempting line item repeals, which may be the best offer we on the Repub side can get right now.

            • I’m sorry for the long responses, guys, but this is really bothering me. And mriggio, as someone who has served in the military, I would guess that you would recognize how dangerous it can be to find yourself dealing with an overly zealous ideologue in a position of authority over you whose irrational response of retribution could present a very real danger, not only to yourself or your company, but to the battle as a whole, correct?

              I wish with all my heart that it wasn’t true, but there isn’t any way to sugar-coat this…we have to walk a fine line on this for the time being.

    • EBL, the amount of power that would be given to IPAB is frightening. It genuinely is. And it should concern all of us how that power might be used, because it doesn’t stop at just the elderly, the handicapped, or those with chronic/terminal diseases. It wouldn’t surprise me one bit to see a board of this type dictate mandatory genetic marker testing, as a bench-mark mechanism, and then use those tests as a means of granting or denying access to health care.

  1. I am curious so if someone can tell me the answer to this please do. It was my understanding that the reason Judge Vinson ruled this travesty unconstitutional is because of the individual mandate and the fact that there is NO SEVERABILITY in o-care. By nibbling around the edges, like removing the 1099 provisions and trying to remove this, will the boy prince and his minions then be able to make a de-facto case that these subsequent changes “granted” severability which would then allow most of this debacle to stand?

    • Suzanne, I’ll try to answer this. I think most of us as conservatives have set our minds on full repeal. And even though I personally would prefer full repeal, the course of action that DHHS has been taking of late alters the situation quite a bit.

      The left genuinely needs a second term in order to get a single-payer health care system up and running, and to have it become entrenched in American society. I’m guessing that they are at least acknowledging the reality that they may not get it. From their viewpoint, the best they can do is to move forward as quickly as they can toward a single-payer system, hoping that the elimination of their competition (i.e private health insurance providers) in the process will alter our traditional health insurance industry to the extent that what’s been done won’t be easily undone.

      Since just before the midterm election, implementation of Obamacare has been picking up speed. DHHS is now running ahead of schedule on implementation. The rulings that have been issued by DHHS lately have been more stringent than need be and have included short deadlines for compliance that make it difficult for private insurance companies to comply with the law.

      For those who have been watching the situation unfold, it looks like DHHS is “gunning” for their competition, no holds barred, consequences be [redacted]. Depending on how quickly things take place during the next 18 months, before the next President is sworn into office, we could lose some private health insurance providers. If this does take place, it is going to drive up health insurance costs for most businesses, and given the current state of economy, that’s a factor we would be better off without.

      And I think that’s the key point that some folks are looking at right now, taking all the factors into consideration.

      If we wait,we could find ourselves facing the reality that what’s been done won’t be easily undone, neither for the health insurance industry nor for businesses, not even by full repeal of the law.

      If we go on the offensive now, even if it is piecemeal, then we might at least have a chance to prevent certain types of damage from being done or alter the scope of damage that is done.

      I think that Obamacare could be repealed, line item by line item, if it came right down to it. Even if it was granted “severability”.

      • Thank you for that.
        I am not, nor would I ever be, a successful political animal… what with being the scorched earth kind of girl that I am and all. I have thus been nothing but disappointed in the House and it’s approach to its sworn full repeal of o-care. I fully expected them to attach an ammendment for its full repeal to every single bill requiring money… and MOST especially making it a condition for raising the debt ceiling. I expected them to make the little cretin veto every bill coming his way which had that as a condition… like on a weekly basis… so the American people could see first hand just exactly what the little {redacted}’s priorities are… all over the six o’clock news (or at least FOX) on a nightly basis. But nooooo. They held their symbolic little vote so they could say they tried and then Boehner used a rules trick to keep a repeal ammendment off a budget bill. Like Bachmann or not, she would have been throwing this at them on a weekly basis.
        And while I’m on this testy little pre-coffee rant this morning, the Tea Party in Ohio better come up with a viable candidate to primary Boehner by the end of this week… it might help his spine stiffen a bit. An KY 1 ought to start a recall petition on Mcconnell… like today.
        Thank you for your explanation and for all that all of you do!

        • Suzanne & lineholder:
          Excuse me for sticking my nose into your conversation here, but I absolutely agree. Our ‘leaders’, esp McConnell, have lost focus chasing this ‘make Obama a 1 term president’, which serves no useful purpose as articulated, just motivates the other side. What became of the battle-cry that the House controls the purse-strings, we can defund O-Care, and BTW, where are the awesome Issa investigations into the shenanigans Reid & Pelosi used to get the monster passed in the first place? Repeal, repeal, repeal attached to each & every item produced by the House, force the Senate to reject or stand pat, rinse & repeat for the next 18 months. Doesn’t seem to be happening.

          • I’m with you. Every damned bill every damned time. And what is truly tragic is that assorted state legislatures doing the redistricting in various states are re-drawing a lot of newly minnted Tea Party Conservatives out of their jobs (see the ever awesome Allen West) so it would appear to be a now-or-never time for us in the House.

            • Yep, and sadly some of the redistricting is being done by R’s not D’s. They hate them some Conservatives!

              McConnell honks me off–making Obama a 1 term president is a great tag-line for Sean Hannity, not so much for our ‘leader’ in the US Senate.

          • mriggio and Suzanne,

            Maybe I should have put a qualifier on a comment that I made earlier…the kind of attitude that DHHS has been displaying is “economic consequences be [redacted]”. Anyone who challenges them is likely to face retribution, Dems and Repubs alike, and it could very well come in the form of economic retribution at that. If it does, it will be we the people who suffer the most. I know, it’s a hard reality to accept, but I think this reality is part of why Repubs have been holding back. They need to see if any sort of break along party lines on the Dems side happens before they make serious challenges to the law.

            Here’s where it may backfire on the admin…if DHHS had taken a responsible approach to implementation of Obamacare, meaning that an objective review of the economic impact of policy implementation was being conducted in process with DHHS responding to that review in a manner that is genuinely in the best interest of our economy…Dems probably would have been content to stay within party lines.

            As time goes by and our economy isn’t improving, the fact that DHHS is continuing to take this type of approach becomes not only extremely irresponsible but also very dangerous economically as well.

            It appears that more Dems are beginning to look at this point realistically, and in doing so, they have to make a choice…do they continue to put party loyalty first or do they put what is best economically first, even if it means facing retribution. A few folks on the Dems side now seem to be at least willing to consider attempting line item repeals, which may be the best offer we on the Repub side can get right now.

            • I’m sorry for the long responses, guys, but this is really bothering me. And mriggio, as someone who has served in the military, I would guess that you would recognize how dangerous it can be to find yourself dealing with an overly zealous ideologue in a position of authority over you whose irrational response of retribution could present a very real danger, not only to yourself or your company, but to the battle as a whole, correct?

              I wish with all my heart that it wasn’t true, but there isn’t any way to sugar-coat this…we have to walk a fine line on this for the time being.

    • EBL, the amount of power that would be given to IPAB is frightening. It genuinely is. And it should concern all of us how that power might be used, because it doesn’t stop at just the elderly, the handicapped, or those with chronic/terminal diseases. It wouldn’t surprise me one bit to see a board of this type dictate mandatory genetic marker testing, as a bench-mark mechanism, and then use those tests as a means of granting or denying access to health care.

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