Medicare pay board is losing vital support

June 8, 2011

One of the key provisions in President Barack Obama’s health care reform law — his preferred method for getting Medicare costs under control — is facing a groundswell of opposition from unexpected corners.

Several House Democrats have signed on to support a bill to repeal the Independent Payment Advisory Board, a panel created by the law that is supposed to help control rising costs in Medicare. The National Committee to Preserve Social Security and Medicare, a prominent supporter of the law, is now actively lobbying for its repeal, too.

The opposition puts some Democrats and a prominent advocacy group on the same side as House Budget Chairman Paul Ryan (R-Wis.) standing against Obama. Ryan has called IPAB a rationing board. The president, for his part, answered Ryan’s budget by proposing an even stronger version of the board than the health reform law created.

For more than a year, the National Committee and other supporters of the reform law who didn’t like the IPAB were willing to put up with it for the greater good of the law. But in recent weeks, that support has waned.

“IPAB turns Medicare into a scapegoat,” said Max Richtman, executive vice president and acting CEO of the National Committee to Preserve Social Security and Medicare. “Medicare will be forced to make reductions without addressing the rest of the health care costs.”

The group also is concerned that it would be hard for Congress to overturn any decisions by the board; it would have to come up with an equal amount of savings to stop the board’s decisions.

It’s a concern echoed by lawmakers, who are most likely to face the political fallout for the board’s actions.

“Abdicating this responsibility, whether to insurance companies or an unelected commission, would undermine our ability to represent the needs of the seniors and disabled in our communities,” Rep. Allyson Schwartz (D-Pa.), a prominent supporter of most of the reform law, wrote in a letter to colleagues in April.

Schwartz has been actively lobbying fellow Democrats to join the Republican repeal measure. So far, the bill has seven Democratic co-sponsors — most recently, Rep. Kathy Castor (D-Fla.).

Sources tell POLITICO that others also have suggested privately that they would support the bill if it comes to the House floor.

The IPAB’s popularity — which has never been high, particularly among House Democrats — is on the decline just as the House’s budget has made the very suggestion of cutting Medicare a red-hot issue on the campaign trail. Republicans, led by Ryan, argue that the IPAB would ration care.

“The president’s new health care law already ended Medicare as [we] know it,” Ryan said on the House floor this month, borrowing from the Democratic rhetoric on his plan. “It does two things: It raids Medicare; and it rations Medicare.”

Democrats argue that the law specifically bans the IPAB from rationing. The board of 15 appointed health experts would, if Medicare growth rose too quickly, be charged with finding savings in the program. It was designed to reach a goal Congress hasn’t been able to achieve: control the rising cost of Medicare.

The White House and Senate Democrats are unlikely to support giving up the policy. Obama doubled down on the IPAB in April during his budget speech, after the House passed Ryan’s budget plan.

“We will slow the growth of Medicare costs by strengthening an independent commission of doctors, nurses, medical experts and consumers who will look at all the evidence and recommend the best ways to reduce unnecessary spending while protecting access to the services seniors need,” Obama said.

The growing support among Democrats has Republicans who have put the IPAB near the top of their health repeal priority list questioning how best to use it.

Rep. Phil Roe (R-Tenn.), the repeal bill’s House sponsor, has floated the idea of trying to attach the IPAB repeal to the debt limit. He argues that the more the public hears about the program, the more likely they are to oppose it.

“Most people haven’t really dug down into the weeds,” he said. “This is a wonky little thing.”

The House Energy and Commerce Committee is expected to hold at least two hearings on the IPAB — the first as soon as next week.

Sen. John Cornyn (R-Texas), the sponsor of the Senate’s bill, said he doesn’t expect the IPAB to be repealed in its first Senate vote.

“We’re getting very close. … I think this is one of the most obnoxious parts of the health care bill that we passed in 2010,” he said. “Nothing’s easy around here, so it may take a couple of votes.”

Senate Republicans could get an opportunity to try to force a vote on an IPAB repeal amendment as soon as this week.

But others suggest making IPAB political could doom its passage — just as repealing the 1099 tax reporting requirements in the law became more difficult the more Republicans said they were taking down the first piece of “Obamacare.”

The “1099s provided an interesting lesson,” a health lobbyist told POLITICO. “It took them eight months. Just firing out test votes probably didn’t accelerate the repeal of 1099s. It may have made it more complicated.”

The other strategy is to slowly build support among Democrats for repeal.

Gathering support among Democrats will be easier in the House than in the Senate, where the idea began. The House health care bill didn’t include the IPAB, and several dozen members expressed their opposition to the board to then-Speaker Nancy Pelosi.

The National Committee says it is talking with lawmakers about its concerns about the IPAB.

“We’ll be meeting with members, trying to persuade them that they need to be responsible, and the responsible thing to do is to scrap that and take on Medicare costs through the regular committee process,” Richtman said.

Health care provider groups have made IPAB repeal a top priority, too. If they can’t repeal the whole provision, they want to eliminate a deal made last year to keep hospitals out of the program until 2018.

“We’re going to raise holy hell if IPAB happens without the hospitals,” a health lobbyist said.