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The International Payment Advisory Board, aka Sarah Palin's "death panels," were supposed to make their first recommendations this month. But, as Kate Nocera at BuzzFeed pointed out, no one has even been nominated yet. Still, the spending bill slashed $10 million from the board's budget, and the main conservative lawsuit against it is moving forward. 

As we've pointed out in the past, the IPAB is not allowed to ration care or kill people off — it simply recommends ways for Medicare to spend less if spending goes over a certain limit. As Kaiser Health News explained in 2012, it's rulings can overruled by Congress with a supermajority vote, but its purpose was to keep spending cut decisions out of the hands of Congress, which is more easily influenced by lobbyists. The IPAB was set to make its first recommendations in January, but that plan has obviously changed. What happened?

The logical answer is that they're not needed yet. In 2011, the Congressional Budget Office predicted that the IPAB wouldn't have anything to do for about a decade, since Medicare costs were "projected to remain below the levels at which the IPAB will be required to intervene to reduce Medicare spending." An administration official confirmed with BuzzFeed that spending is below IPAB-necessary levels. But that hasn't stopped the conservative-led lawsuit against, or the outrage of patriots over the "obnoxious violations of Madisonian principle and essential constitutional structure," as Quin Hillyer writes at National Review on Wednesday. One case, Coons v. Lew, is set to be heard by the Ninth Circuit Court of Appeals eventually. It targets many aspects of the law, including the IPAB. According to Hillyer:

One of the plaintiffs, Eric Novack, a medical doctor, faces potential cuts in his reimbursement rates via IPAB decrees; he and Goldwater challenge IPAB for violating the Constitution’s separation of powers.

That "potential" is key, since, as we just pointed out, the IPAB probably isn't going to do anything for a few years. But that's not really the point of this lawsuit. As Hillyer writes, "Striking down IPAB, the most powerful cost-control mechanism in all of Obamacare, could be the last straw in making the whole law unworkable, leading to its demise." The IPAB is unpopular with doctors worried about their Medicare reimbursements and Democrats worried about angry constituents, making it a potential weak point. Whether it currently exists right now is beyond the point. 

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