The Independent Payment Advisory Board (IPAB) was established under the Affordable Care Act (ACA) with the mission of reducing the growth rate of Medicare spending. The necessary conditions to trigger IPAB activity have not yet been met. Consequently, there has been no IPAB activity, and no members have been nominated to the board. In July 2016, the Centers for Medicare & Medicaid Services’ (CMS) chief actuary stated in his letter to the CMS administrator that the growth in Medicare per capita spending was less than the target growth rate, and therefore the IPAB would not be triggered for 2016. However, the chief actuary and the Medicare trustees believe that the IPAB will be triggered in 2017, followed by several years of volatility when the IPAB may or may not be triggered. According to the chief actuary, the volatility is due to statutory methodology changes in assessing when IPAB activity is triggered.