Health and Human Services Secretary Kathleen Sebelius defended the Independent Patient Advisory Board (IPAB) and attempted to redirect focus from IPAB to the House GOP’s proposed Medicare reforms at a House hearing this morning on Capitol Hill.

“The Independent Patient Advisory Board makes recommendations to Congress,” said Sebelius, who was testifying before the health subcommittee of the House Energy and Commerce Committee. “It is forbidden by law to do exactly what the Republican budget plan does. They may not shift costs to seniors. They may not change benefits.”

IPAB, the controversial independent board provided for in President Obama’s health care law, was the focus of the hearing, which was the second of two House hearings this week before which Sebelius was called. She testified before the Budget Committee yesterday to defend IPAB.

Rep. Joe Pitts (R-Penn.), the subcommittee chairman, noted in his opening remarks that there is “widespread opposition” to IPAB including bipartisan opposition within Congress. “This is not surprising, since the decisions of the board will become law by a fast track process that will bypass the usual legislative procedures, in effect superseding the customary jurisdiction of committees like this one,” said Pitts. Indeed, Rep. Frank Pallone (D-N.J.), the ranking member on the subcommittee, also voiced his opposition to IPAB, and Rep. Allyson Schwartz (D-Penn.) testified earlier in the hearing that “IPAB is simply the wrong approach to achieving the right goal.”

But Sebelius was defiant against claims that IPAB risks usurping the power of Congress to make changes to Medicare. “All final decisions remain in the hands of Congress,” Sebelius said in her prepared statement. “If Medicare costs are rising at an unsustainable rate, it’s Congress’s choice whether to accept those recommendations, or come up with recommendations of its own to put Medicare spending on a stable, sustainable path.” She reiterated her argument from yesterday’s Budget hearing that IPAB serves as a “backstop to ensure Medicare remains solvent for years to come.”

During his questioning, Pitts asked Sebelius to consider a hypothetical scenario wherein IPAB made recommendations that Medicare reduce its reimbursement payments for dialysis procedures. Pitts inquired if seniors would be affected by reduced access to dialysis services.

“If Congress accepted the recommendations and made the decision that cuts in dialysis were appropriate,” Sebelius replied, “I assume there could be some providers who would decide that would not be a service they would any longer deliver, the same way they do with insurance providers each and every day.”

“Would that mean some seniors have to wait longer for dialysis?” Pitts asked.

“Mr. Chairman, as you know, any cut in services, certainly cost shifting to beneficiaries, could mean huge reductions in care that seniors would have the opportunity to receive,” said Sebelius.

At times, the hearing shifted toward discussion about the House Republicans’ Medicare reform plan, with Sebelius often pivoting from defending IPAB and Obamacare to criticizing what she called the GOP’s “voucher” system. Rep. Michael Burgess (R-Tx.) asked Sebelius to explain the difference between a voucher system and a premium support system.

“A voucher is basically, in insurance terms, a guaranteed contribution, as opposed to a guaranteed benefit,” said Sebelius “Those are very different concepts. On one hand, in the current Medicare program, seniors and those with disabilities have guaranteed benefits. That would switch with a voucher.”

“What would premium support be?” Burgess asked.

“I’m not as familiar with that term,” Sebelius said.

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