The Independent Payment Advisory Board (IPAB) is set to take effect in 2014, and would comprise 15 President-appointed and Senate-confirmed experts charged with holding down Medicare per-beneficiary spending by restricting reimbursements to providers. It is forbidden from cutting payments to beneficiaries. Congress can override the panel is by passing an alternate way to save the same amount of money, or with a three-fifths Senate majority. The health care industry has been outspoken in its hatred for IPAB. Republicans are united in their effort to kill it, and even some House Dems are on that page.