Just a quick note. I have written previously about the Independent Payment Advisory Board. The budget legislation signed today, permanently repeals its existence. To return to my original metaphor, the final stake has been driven into its heart.
Created as part of the Affordable Care Act, and part its continuing structural dismantling by the Trump administration it was a cost-control mechanism designed to maintain individual beneficiary costs of Medicare within certain guidelines. It's appointed members had no accountability and could recommend significant payment cuts. Those decisions will now rest with the newly confirmed Secretary of Health and Human Services, Alex Azar. The decision comes at a good time since there is an expectation that Medicare may exceed its statutory limits in the future.