When the Obama administration first proposed its massive overhaul of the nation’s healthcare system, opponents raised concerns that government officials would be making decisions about healthcare not on the basis of a patient’s needs, but based on bureaucratic spending limits and one-size-fits all political decrees.

Critics were especially alarmed over a provision in the Affordable Care Act that creates an agency called the Independent Payment Advisory Board and charges it with limiting the growth of Medicare spending. The board will set the payment rates healthcare providers will receive for treatments and services of Medicaid patients.