(AP) House repeals Medicare cost board on party lines
By RICARDO ALONSO-ZALDIVAR
Associated Press
WASHINGTON
Drawing a new election-year fault line between the parties, the Republican-controlled House voted Thursday to repeal a Medicare cost-control board that has yet to be named but is called for in President Barack Obama’s health care overhaul law.
The GOP has branded the Independent Payment Advisory Board a rationing panel, and Republicans hope the symbolic 223-181 vote to repeal it will persuade seniors that they, and not the Democrats, are the best stewards of Medicare.
IPAB would have the power to force cuts to service providers like drug companies if Medicare costs rise beyond predetermined levels. A Republican Medicare plan announced this week would also limit Medicare cost increases, but rely more on market competition.
If it sounds like a debate among Washington insiders, Rep. Jack Kingston, R-Ga., said he would have no trouble explaining to constituents why he voted to repeal the board.
“Do you remember death panels?” said Kingston, referring to the debunked accusation by former GOP vice presidential candidate Sarah Palin that Obama’s health care law would allow bureaucrats to withhold life-saving care from the elderly.
“It’s not necessarily a death panel, but it is a rationing panel and rationing does lead to scarcity for some,” he added. “Who’s going to get the needed treatment, an 85-year-old or the 40-year-old with children?”
The health care law explicitly bars the board from rationing care, shifting costs to Medicare recipients or cutting their benefits. But critics say squeezing service providers will stifle medical innovation, achieving a similar result.
Many House Democrats also oppose the board, but for different reasons. They feel it diminishes the role of Congress in deciding Medicare policy. But Republicans made it difficult to attract Democratic votes for repeal by adding other politically charged provisions to their bill.
“Republicans don’t want to see IPAB repealed now because they want to run against it,” said Scott Gottlieb, a former senior FDA official in the George W. Bush administration. “I think there will be an effort to repeal it after the election.”
The House vote came a day before the second anniversary of the health care law, and just ahead of next week’s Supreme Court deliberations on its constitutionality. Political gamesmanship aside, it highlighted major differences between the parties on Medicare, the giant health care program for nearly 50 million seniors and disabled people.
All sides agree that Medicare as currently structured will not be able to pay its bills in the long run. The main options to control costs are unpalatable: tax increases, benefit cuts and cost shifts to middle- and upper-income retirees. Most Republicans and Democrats also agree now that there has to be a limit on future Medicare increases. The question is how.
Republicans would convert Medicare into a system dominated by private health insurance plans closely regulated by the government. Future retirees would get a fixed payment to buy either private coverage or sign up for a new government plan modeled on traditional Medicare. They count on competition among the plans to help keep costs in check, but the annual government payment would also be limited by tying it to a measure of economic growth.
That’s the basic approach embodied in the new budget released this week by Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee, and seconded by GOP presidential candidate Mitt Romney.
Theoretically, such a system could help rein in Medicare cost increases, economists say. The question is whether it would be politically acceptable to seniors and future generations, with polls indicating that the public is resistant to major changes. Recognizing the sensitivity, Ryan’s plan would exempt anyone now 55 or older.
Obama and the Democrats would take a far different approach to cost control, and that’s where the IPAB board comes in.
IPAB has the power to force payment cuts to service providers if costs rise beyond certain levels and Congress fails to substitute its own plan for savings. But the law explicitly forbids the board from rationing care, shifting costs to seniors, or cutting their benefits. The Democrats would put the burden on service providers, such as drug companies, insurers and eventually, hospitals.
Obama has yet to name anyone to the panel, whose 15 members must be confirmed by the Senate. Government economists are forecasting a period of manageable Medicare costs, meaning that IPAB’s services may not be needed until sometime around the end of the decade.
Democrats say they’d rather defend IPAB any day in front of older voters _ and attack the GOP’s Medicare overhaul.
“The rationing is in the Republican plan,” said Rep. Chris Van Hollen, D-Md., the ranking Democrat on the budget committee. “What they do is allow insurance companies to ration people’s health care.”
The nonpartisan Congressional Budget Office said this week that both Obama’s health care law and the new Ryan plan could potentially create access-to-care problems for Medicare recipients. The CBO cautioned that those could turn out to be greater under the GOP approach, which would squeeze Medicare growth harder. Republicans say that won’t happen because competition among health plans will keep costs down by reducing waste.
The House bill is likely to hit a dead end in the Senate. The White House issued a veto threat against it earlier this week. House Republicans all but guaranteed that when they paired by IPAB repeal with caps on medical malpractice awards, which most Democrats oppose.
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