White House Adviser on IPAB: Do You Really Want Congress Making Decisions?

White House Adviser on IPAB: Do You Really Want Congress Making Decisions?

Liz Fowler, a presidential adviser who helped develop Obamacareduring her time on Capitol Hill, spoke at a high profile conference ofdoctors in April. Other speakers included HHS Secretary KathleenSebelius, former CMS Director Donald Berwick, and Jon Carson, Director ofWhite House Public Engagement. During a Q&A session, Fowler was asked about the Independent PaymentAdvisory Board (IPAB). Her response suggested that Congress was not thebest place to make critical decisions about Medicare’s future.

Having spent eight years on Capitol Hill and I have great respectfor Congress, obviously, but look what happened to the debt ceiling lastyear. Is that really the body that you want, when push comes to shoveand you’re right up against the line of something really tragichappening and Medicare is about to go belly up. Is that really the placethat you want to by making the decisions? 

Ms. Fowler, whose full title is Special Assistant to the Presidentfor Healthcare and Economic Policy at the National Economic Council,previously worked on Capitol Hill and helped Sen. Max Baucus developthe Affordable Care Act. Her answer may betray a personal weariness withthe 18month sausage-grinding process that led to passage of the ACA inCongress. However, it also fits into a broader narrative aboutObama’s White House, i.e. that it is increasingly comfortable bypassingCongress entirely and using executive power to accomplish its goals.Just a day before Ms. Fowler’s statement at the conference, the NY Timespublished a story highlighting the President’s intentional shift towardthe use of executive power:

The Obama administration started down this path soon after Republicanstook over the House of Representatives last year. In February 2011, Mr.Obama directed the Justice Department to stop defending the Defense ofMarriage Act, which bars federal recognition of same-sex marriages,against constitutional challenges. Previously, the administration hadurged lawmakers to repeal it, but had defended their right to enact it.

In the following months, the administration increased efforts to curbgreenhouse gas emissions through environmental regulations, gave stateswaivers from federal mandates if they agreed to education overhauls, andrefocused deportation policy in a way that in effect granted relief tosome illegal immigrants brought to the country as children. Each stepsubstituted for a faltered legislative proposal.

Also mentioned later in the story was the President’s highlycontroversial use of recess appointments to bypass Senate confirmationhearings of four officials. The Senate had been holding pro formasessions during the recess to prevent this, but after consulting withhis attorneys, the White House decided they could ignore these and makethe 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 recommendationof Congress, not a move by the executive branch. But it is interestingthat Ms. Fowler, who has served the President for more than a yearhelping to implement the ACA, has adopted a defense of the controversialadvisory board which is consistent with the White House’s broaderagenda. In fact, according to the NY Times, the White House shift onexecutive power came as a result of the same turning point cited by Ms.Fowler:

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 hasgiven up, not only practically but theoretically, on the legislativebranch. This divide could become much more pronounced if the Presidentwins reelection but Democrats fail to retake the House ofRepresentatives.