There was a time when the Independent Payment Advisory Board — the panel that's supposed to recommend Medicare cuts if the spending grows too fast — was one of the most unpopular parts of the Affordable Care Act. Then it just disappeared until you forgot it was part of the storyline, kind of like Mama Pope on Scandal.
Now it could return, as Nicholas Bagley of the University of Michigan law school points out — because there will probably be a "determination" soon about whether Medicare spending is growing fast enough to trigger the IPAB cuts. It didn't happen last year, but Medicare spending could be high enough this year to require the cuts — a ruling that would be made by the chief Medicare actuary.
So, just in case, here are some IPAB facts you need to know:
It doesn't actually exist right now. Neither President Donald Trump nor former President Barack Obama ever appointed anyone to the board. So if the Medicare cuts have to happen, they would actually be made by the Department of Health and Human Services — if HHS secretary Tom Price can bring himself to do it.
IPAB isn't included in the House ACA repeal bill. Despite being a repeal target for years, it's not included because Republicans can't do it under the budget "reconciliation" rules.
But the board could be repealed separately. There are standalone IPAB repeal bills, including one from Rep. Phil Roe, that Republicans could take up if the Medicare cuts look like a real possibility. A senior GOP aide says IPAB repeal "is something that has bipartisan support and committees in the House are actively considering."
It will be a while before we know. The determination about Medicare cuts would be made around the same time as the next Medicare trustees meeting, according to an administration official, and that meeting hasn't been scheduled yet. Last year, it happened in June.