According to a recent Congressional Research Service report, estimating the number of agencies, boards and commissions created under the new health care law is 'impossible.' Health reform's bureaucratic spawn

Don’t bother trying to count up the number of agencies, boards and commissions created under the new health care law. Estimating the number is “impossible,” a recent Congressional Research Service report says, and a true count “unknowable.”

The reasons for the uncertainty are many, according to CRS’s Curtis W. Copeland, the author of the report “New Entities Created Pursuant to the Patient Protection and Affordable Care Act.”


The provisions of the law that create the new entities vary dramatically in specificity.

The law says a lot about some of them and a little about many, and merely mentions a few. Some have been authorized without any instructions on who is to appoint whom, when that might happen and who will pay.

Those agencies created without specific appointment or appropriations procedures will have to wait indefinitely for staff and funding before they can function, according to Copeland’s report.

And others could be just the opposite: One entity might not be enough and could spawn others, resulting in an “indeterminate number of new organizations.”

The CRS report cites as an example a minority health provision that “requires the heads of six separate agencies within Health and Human Services to each establish their own offices of minority health.”

Another section, by contrast, says that the Patient-Centered Research Institute “‘may appoint permanent or ad hoc expert advisory panels as determined appropriate.’ How many such panels will be ‘determined appropriate’ by the institute is currently unclear.”

Implicit in the report is a message not to take too seriously the elaborate charts and seemingly precise numbers peddled by Republican critics that are designed to show the law’s many bureaucratic tentacles.

The Center for Health Transformation, founded by Newt Gingrich, recently estimated that the new law created as many as 159 new offices, agencies and programs. Republican staffers on the Joint Economic Committee determined that there were 47 bureaucratic entities.

“Although some observers have asserted that PPACA will result in a precise number of new boards and commissions,” the CRS document reads, “the exact number of new organizations and advisory bodies that will ultimately be created ... is currently unknowable.”

Even in the few cases in which the PPACA set explicit creation dates for organizations, the consequences of missing these deadlines remain unknown.

The legislation, for instance, mandated HHS to establish an Interagency Task Force to Assess and Improve Access to Health in Alaska by May 7, as well as an Advisory Committee on Breast Cancer in Young Women by May 22.

HHS has yet to appoint members to the breast cancer committee and is currently reviewing nominations, according to HHS spokeswoman Jessica Santillo. The Alaska task force didn’t hold its first meeting until July 16.

The CRS author based his conclusions on a search of the law for any of the following formulations: “there is established,” “there is created,” “there is hereby created,” “shall establish,” “shall create,” “shall convene,” “shall appoint,” “purpose of this section to establish,” “there is hereby established” and “there is authorized to be established.”

Beyond the problem of enumeration, the CRS paper expresses concern that the lack of specificity in the bill could complicate congressional oversight. Copeland also raises questions about the number of appointments to boards delegated to the comptroller general of the United States, who heads the Government Accountability Office.

“Under the new law, the Government Accountability Office must appoint at least 83 new members to six new boards,” he notes. “It is unclear how GAO will be able to independently audit these entities when the CG has appointed their members.”

Some of these new “entities” have been politically controversial.

For instance, prominent Senate Republicans introduced legislation last week to repeal the Independent Payment Advisory Board, which must submit Medicare cost-cutting proposals to Congress and will consist of 15 members, appointed by the president and confirmed by the Senate.

“America’s seniors deserve the ability to hold elected officials accountable for the decisions that affect their Medicare,” Sen. John Cornyn (R-Texas) said in a statement, “but IPAB and many of these other new boards would take that away from seniors and put power in the hands of politically appointed Washington bureaucrats.”

Cornyn, one of five senators calling for the IPAB repeal, further denounced the number of new boards created by the PPACA. “This avalanche of new boards is arrogantly premised on the idea that Washington has all the answers,” he wrote in an e-mail to POLITICO. “In true fashion of Obama-Reid-Pelosi hubris, this is an outrageous growth in government.”

The political battle over IPAB is especially consequential because its proposals will not be merely advisory. PPACA mandates the secretary of HHS to implement IPAB’s proposals unless Congress adopts alternative measures to cut at least as much Medicare spending as the original IPAB recommendations.