House Democrats' defections threaten Obama's Medicare advisory board

Rep. Allyson Schwartz (D-Pa.) on Friday urged lawmakers to repeal a controversial provision of the healthcare reform law that President Obama says is central to his deficit-cutting efforts.

Obama in his deficit speech Wednesday urged lawmakers to strengthen the law's Independent Payment Advisory Board (IPAB), which sets Medicare cost targets and recommends payment cuts if they're exceeded. In a "Dear Colleague" letter just two days later, Schwartz instead advocates for getting rid of the board altogether.

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"While I embrace the goal of reducing costs," she wrote, "I cannot condone the implementation of a flawed policy that will risk beneficiary access to care.

"We can and will address the unsustainable rate of growth in health care spending. Repeal of IPAB will allow us to focus our efforts on the promotion of thoughtful innovations that will achieve cost savings by incentivizing efficient, high quality care for all Americans," she wrote.

Schwartz isn't the first Democrat to sign onto Rep. Phil Roe's (R-Tenn.) IPAB repeal bill: Reps. Shelley Berkley (D-Nev.), Michael Capuano (D-Mass.) and Larry Kissell (D-N.C.) jumped on board last month. But her timing and prominence — Schwartz is a healthcare reform champion and vice chairwoman of the New Democrat Coalition — makes hers the most prominent Democratic defection so far.

The move adds to already serious doubts that Obama will be able to garner enough votes to strengthen the IPAB, as he proposed in his deficit speech Wednesday. The president wants to lower the growth target at which the IPAB kicks in and create sequestration authority if it's exceeded, but healthcare providers — including pro-reform allies such as hospitals — are strongly opposed.

An administration official declined to comment for this story.

But the president has already made his case as to why the IPAB is a crucial component of the healthcare reform effort.

"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 that seniors need," Obama said in his speech. 

"Now, we believe the reforms we've proposed to strengthen Medicare and Medicaid will enable us to keep these commitments to our citizens while saving us $500 billion by 2023, and an additional $1 trillion in the decade after that. But if we're wrong, and Medicare costs rise faster than we expect, then this approach will give the independent commission the authority to make additional savings by further improving Medicare."