The Affordable Care Act established a 15-member Independent Payment Advisory Board (IPAB) to reduce Medicare spending growth using a target system and fast-track legislative approval process. By April 30 of each year, the Centers for Medicare & Medicaid Services will project whether Medicare’s per-capita spending growth rate in the following 2 years will exceed a target rate. Initially, the targeted rate of spending growth will be based on the projected 5-year average percentage increase in the Consumer Price Index for all urban consumers. Beginning in 2019, the target will be set at the nominal gross domestic product per capita plus 1.0%. If future Medicare spending is projected to exceed the targets, the IPAB will propose recommendations to reduce the growth rate.   ■