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Bipartisan Bill Would Kill Obamacare Cost-Cutting Board

By Melissa Attias, CQ Roll Call

March 2, 2015 -- A bipartisan pair of House lawmakers plans to drop legislation soon to scrap a controversial Medicare cost-cutting board created by the health care law, pitching the measure as an effort to restore authority to Congress rather than to gut President Barack Obama's signature legislative achievement.

California Democrat Linda T. Sánchez, who will introduce the repeal bill with Tennessee Republican Phil Roe, said lawmakers knew that the health care overhaul wouldn't be perfect and that the Independent Payment Advisory Board (IPAB) is "one of the parts to the bill that many Democrats were not enamored of" before it even passed.

The board was included in the law to make annual cost-cutting recommendations to Medicare, the federal health program for the elderly and disabled, if spending exceeds a target growth rate. The board's proposals would be implemented automatically unless Congress acts to make cuts that meet requirements laid out in the law.

The mere prospect of creating the board helped stoke charges that the law would lead to a rationing of patient care and create "death panels." But the conditions for triggering the panel's recommendations haven't been met, and Obama hasn't appointed any members.

Sánchez's main concern is that the provision cedes congressional authority to an unelected, unaccountable body.

"When it comes down to questions of how to cut costs, we think it's better left to the members of Congress who have constituents that we're answerable to," said Sánchez, who noted that she took over as the lead Democrat on the bill when former Rep. Allyson Y. Schwartz of Pennsylvania left at the end of last Congress.

Roe echoed Sánchez's sentiments in a joint interview, maintaining that lawmakers are directly accountable to constituents and that the power should be returned to Congress. While he acknowledged that there is a "healthy skepticism" when a conservative Republican tries to convince a Democrat to sign onto a bill, he said Sánchez brings credibility to the cause.

As of late last week, the yet-to-be introduced legislation had more than 200 cosponsors, including 17 other Democrats.

Although Sánchez said some will try to characterize the bill as an attack on the health law, she emphasized that she doesn't advocate for repeal and that the law has greatly increased access to health care in the Latino community. She's continuing to talk to fellow Democrats about the measure and about trying to find an alternative to IPAB.

Support among Democrats could depend on whether the measure is combined with other health proposals. Frank Pallone Jr. of New Jersey, the top Democrat on the House Energy and Commerce Committee, opposes the board but voted against legislation in 2012 that combined its repeal with a medical malpractice measure.

Roe said he has not yet spoken to Republican leadership about committee or floor consideration, though Sánchez pointed to the Ways and Means Committee's recent action on four bipartisan health bills and said she hopes Chairman Paul D. Ryan, R-Wis., will see this as another bipartisan measure to move forward. Ways and Means and Energy and Commerce share jurisdiction over health issues.

The panel could also play a role in finding a way to offset the price tag of killing the board, since the Congressional Budget Office estimated in 2012 that repealing IPAB would cost $3.1 billion over a decade. But Sánchez said the committee "seems to be operating without a lot of concern for pay-fors," citing tax extender legislation, and said she's not sure if finding an offset will be an imperative.

"On certain things, people tend to raise a ruckus about pay-fors," she said. "And then on the other hand, on other issues, pay-fors don't kind of seem to matter."

Roe agreed that the push for offsets comes and goes, adding that he doesn't think repeal will have a very high score and the cost shouldn't be something that stops the bill from advancing.

Lightning Rod

Intended to reduce political influence over Medicare decisions, the board has long drawn concern for its broad authority and is a favorite target for Republicans. Though some critics have raised the specter of rationing, the law states IPAB cannot "ration health care," restrict benefits, raise premiums or cost-sharing requirements, or change eligibility rules.

Last week, Republicans asked Health and Human Services Secretary Sylvia Mathews Burwell about the board at two House hearings. Andy Harris of Maryland pressed her on whether the administration plans to appoint members this year, but Burwell said officials are waiting on recommendations from Congress. Larry Bucshon of Indiana also questioned when the board will begin to make recommendations under the president's budget, and Burwell said it would not kick in until 2019.

Still, Roe said he knows it would cause disruption and pushed for Congress to act before the board is triggered. Sánchez agreed that the "wiser course of action" is to head it off before it becomes a crisis, citing Congress' tendency to wait until the last minute to act, causing panic.

"Congress doesn't exactly have the reputation for moving at a very quick pace," she said.

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