White House Adviser on IPAB: Do You Really Want Congress Making Decisions?
Liz Fowler, a presidential adviser who helped develop Obamacare
during her time on Capitol Hill, spoke at a high profile conference of
doctors in April. Other speakers included HHS Secretary Kathleen
Sebelius, former CMS Director Donald Berwick, and Jon Carson, Director of
White House Public Engagement. During a Q&A session, Fowler was asked about the Independent Payment
Advisory Board (IPAB). Her response suggested that Congress was not the
best place to make critical decisions about Medicare's future.
Having spent eight years on Capitol Hill and I have great respect
for Congress, obviously, but look what happened to the debt ceiling last
year. Is that really the body that you want, when push comes to shove
and you’re right up against the line of something really tragic
happening and Medicare is about to go belly up. Is that really the place
that you want to by making the decisions?
Ms. Fowler, whose full title is Special Assistant to the President
for Healthcare and Economic Policy at the National Economic Council,
previously worked on Capitol Hill and helped Sen. Max Baucus develop
the Affordable Care Act. Her answer may betray a personal weariness with
month sausage-grinding process that led to passage of the ACA in
Congress. However, it also fits into a broader narrative about
Obama's White House, i.e. that it is increasingly comfortable bypassing
Congress entirely and using executive power to accomplish its goals.
Just a day before Ms. Fowler's statement at the conference, the NY Times
published a story highlighting the President's intentional shift toward
the use of executive power:
The Obama administration started down this path soon after Republicans
took over the House of Representatives last year. In February 2011, Mr.
Obama directed the Justice Department to stop defending the Defense of
Marriage Act, which bars federal recognition of
against constitutional challenges. Previously, the administration had
urged lawmakers to repeal it, but had defended their right to enact it.
In the following months, the administration increased efforts to curb
greenhouse gas emissions through environmental regulations, gave states
waivers from federal mandates if they agreed to education overhauls, and
refocused deportation policy in a way that in effect granted relief to
some illegal immigrants brought to the country as children. Each step
substituted for a faltered legislative proposal.
Also mentioned later in the story was the President's highly
controversial use of recess appointments to bypass Senate confirmation
hearings of four officials. The Senate had been holding pro forma
sessions during the recess to prevent this, but after consulting with
his attorneys, the White House decided they could ignore these and make
the appointments anyway. Critics of the move, including former attorney general Ed Meese, called it unconstitutional.
As Ms. Fowler explains in her answer, IPAB was a recommendation
of Congress, not a move by the executive branch. But it is interesting
that Ms. Fowler, who has served the President for more than a year
helping to implement the ACA, has adopted a defense of the controversial
advisory board which is consistent with the White House's broader
agenda. In fact, according to the NY Times, the White House shift on
executive power came as a result of the same turning point cited by Ms.
It was only after the summer, when negotiations over a deficit reduction deal broke down and House Republicans nearly failed to raise the nation’s borrowing limit, that Mr. Obama fully shifted course.
Ms. Fowler's statement reinforces the idea that the White House has
given up, not only practically but theoretically, on the legislative
branch. This divide could become much more pronounced if the President
wins reelection but Democrats fail to retake the House of