TightWind is written by Kyle Baxter. Stay Hungry. Stay Foolish.

The Independent Payment Advisory Board was created by PPACA, Obama’s 2010 healthcare reform law, to restrain the growth of Medicare spending. The IPAB’s board members are appointed by the president, and if Medicare spending is estimated to exceed targets, they are required to make “recommendations” to Congress for reducing Medicare payments to providers that have the force of law. Basically, unless Congress overrides their recommendation with their own plan (which is difficult to do, because Congress’s alternative plan must reduce Medicare spending by the same amount as the IPAB’s recommendation during that year).

Which means that the IPAB is an unelected group with the power to make law.

What’s worse, though, is PPACA makes it almost impossible for Congress to eliminate the IPAB. Reason’s Peter Suderman writes:

That’s the other catch: ObamaCare doesn’t just create IPAB. It also sets in place a series of barriers designed to make it extremely difficult to repeal. So if Congress wants to get rid of IPAB, it will have to jump through a complex set of hoops first.

That means acting swiftly and with great unity. The health care overhaul contains a provision labeled Joint Resolution Requirements to Dissolve the Board that lays out exactly the steps that Congress must follow if it wants to take down IPAB. The provision lays out in great detail what a joint resolution to dissolve IPAB would have to look like, and then sets out a further requirement that it must be introduced between January 1 and February 1, 2017—meaning Congress would have to act in just a few working days. 

Following the introduction of the legislation, Congress would have to pass the joint resolution with a supermajority of sworn members by August 15 of the same year. “If you don’t do that,” Cohen says, “Congress has no option, at all, to repeal the board.” Meanwhile, even if the board were successfully dissolved, IPAB would keep issuing its recommendations, which would still have the force of law, until 2020.

So not only is the IPAB anti-democratic, but it also is nearly impossible to get rid of it. Amusing that a party which calls itself the “Democrats” would create such a wildly anti-democratic law.