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News May 2012

Washington Watch

Newest Repeal Effort to Health Care Reform Bill: Medicare Cuts Advisory Board

By Alan M. Schlein

If Medicare spending exceeds a certain target, the panel would make recommendations to Congress on how to lower Medicare spending, but with specific restrictions -- including no increases to beneficiaries -- premiums or cost sharing or cuts to benefits.

c_stingeracafight_sWhile the U.S. Supreme Court is focused on the constitutionality of the health care reform law and specifically, the individual mandate, Congress is busying trying to undercut another important piece of the overall legislation.

The Republican-controlled House of Representatives is likely to pass legislation that would repeal an advisory board created in the 2010 health law to curb Medicare spending if it exceeds specific targets.

While that may not sound controversial -- if anyone remembers the 2009 uproar over so-called end of life “death panels,” and “health care rationing” -- this advisory board was created to recommend cuts to Medicare.

Already, the House Ways and Means Committee, and separately the House Energy and Commerce Committee, have each approved legislation repealing the health care overhaul law’s provision establishing the Independent Payment Advisory Board (IPAB). Full House approval is expected even before the U.S. Supreme Court hears oral arguments on the individual mandate at the end of March, although the Senate has not agreed to consider any kind of repeal.

Under the law, as it exists, President Obama will nominate the 15 people to serve on IPAB subject to Senate approval. If Medicare spending exceeds a certain target, the panel would make recommendations to Congress on how to lower Medicare spending, but with specific restrictions -- including no increases to beneficiaries -- premiums or cost sharing or cuts to benefits. So far no one have been named to the panel.

While recommending cuts to save money is one interpretation, others see it very differently.\As the conservative magazine, the American Spectator, explains the IPAB board: “Its sole purpose is to cut funding for some health care services seniors now take for granted. And those cuts will kill people.”

Or as conservative opinion columnist Sally Pipes, president of the Pacific Research Institute, wrote recently in Forbes Magazine if Congress doesn’t kill off the IPAB provision: “American seniors could face the prospect of government-rationed health care.”

The House was expecting to pass the repeal legislation but prospects of it getting anywhere in the U.S. Senate remain in doubt and there are strong objections by the Obama administration.

The 2010 law says that beginning in 2015, the IPAB board would have the power to recommend cuts not exceeding 0.5 percent of Medicare spending, increasing to 1.5 percent for 2018 and beyond. If Congress fails to pass legislation to lower spending that matches the levels recommended by the board, then the board’s recommendations would automatically take effect.

The IPAB fight is not strictly a Democrat versus Republican fight like most of the efforts to repeal health care reform are. Last fall, 20 medical associations urged Congressional budget cutters to repeal the IPAB board, arguing it lacked transparency and accountability, and that strict budgetary targets would result in limiting seniors’ access to health care.

One interesting twist to the IPAB fight is the legislation’s effects on the deficit. While conservative Republicans constantly criticize Democrats for federal government spending largess, the deficit argument has hardly been mentioned by lawmakers in the IPAB battle. That gave an opening for Health and Human Services Secretary Kathleen Sebelius, a Democrat and former governor of Kansas, who recently came out strongly against repealing IPAB, saying it would add “billions of dollars to the federal budget deficit while repealing an ‘important tool’ to strengthen the Medicare program.”

The debate over IPAB is not shaping up as the usual partisan legislative fight where Republicans want to strike or repeal a provision and Democrats want to stop it. On this fight, some key Democrats, such as Rep. Pete Stark, D-Calif., the ranking Democrat on the House Ways and Means Health Subcommittee and Rep. Frank Pallone, D, N.J., the ranking member on the House Energy and Commerce Health Subcommittee, both want IPAB gone altogether. Their reason is that Congress should maintain the power it has to control spending, and they don’t want Congressional power given over to the executive branch.

Like the automatic spending cut triggers used routinely in budget issues, Congress would have to consider these proposals on a fast track basis and if lawmakers disliked them, they would have to pass alternatives that would achieve the same level of savings. If Congress fails to act, the secretary of Health and Human Services would have to implement the IPAB recommendations.

One thing is clear, don’t be surprised to hear talk about “death panels,” throughout the election process.


Also contributing to this report were: Kaiser Health, New York Times, CNN, USA Today and the Los Angeles Times.

Alan Schlein has been covering the national Washington beat for Senior Wire News Service for over two decades.

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