Bipartisan legislation to repeal the healthcare law's cost-control board sailed through a House panel on Wednesday, raising pressure on the Senate to take up the bill and dealing President Obama a political blow.
The Energy and Commerce Health subcommittee vote was 17-5, with ranking member Frank Pallone Jr. (D-N.J.) and Rep. Edolphus Towns (D-N.Y.) crossing the aisle to vote for repeal of the Independent Payment Advisory Board. There were no amendments.
Panel Chairman Joe Pitts (R-Pa.) opened the repeal markup by arguing that the 15-member board, which Republicans label a "rationing board" - repeal bill sponsor Phil Roe (R-Tenn.) has even called it "the real death panel" - would supplant lawmakers' ability to run Medicare policy. The board is tasked with recommending provider payment cuts if Medicare costs grow faster than a targeted rate; Congress could propose its own equivalent savings with a simple majority or overturn the recommendations with a supermajority.
"Supporters of IPAB tell us there is nothing wrong with having 15 unelected bureaucrats making binding decisions about Medicare policy," Pitts said.
"They are not troubled by the fact that there is no requirement for public comment prior to IPAB issuing its recommendations. That IPAB's actions are not subject to judicial review does not alarm them."
The law prohibits the board from making any recommendations that would ration care, reduce benefits, raise premiums or cost-sharing or alter eligibility for Medicare.
However, Pitts pointed out that the term "rationing" is not defined anywhere.
"For example," he asked, "is it rationing if IPAB slashes provider reimbursements to the point that doctors decide they can no longer see Medicare patients?"
Democrats sought to gloss over their internal divisions by focusing their attacks on Republicans.
Pallone suggested Republicans on the panel were hypocrites for framing their vote as an effort to protect Medicare when they all voted for last year's House budget that would have replaced the program with subsidies for seniors to buy private insurance plans. Critics of the so-called "premium support" proposal say it would shift costs from the federal government onto seniors.
"Last year," he said, "every single one of you voted to end Medicare as we know it."
He said his vote in favor was aimed not at weakening the healthcare reform law but to "stop ceding legislative power to the executive branch."
"I do not see IPAB as a significant factor in the Affordable Care Act," Pallone said.
Republicans first began to argue that provisions of the healthcare law would harm seniors when former New York Lieutenant Governor Betsy McCaughey made the argument in reference to a Medicare provision that would have allowed physicians to be reimbursed for end-of-life counseling. The provision was removed from the final version of the bill.
The term "death panel" is believed to have originated with former Alaska Gov. Sarah Palin, though it is not clear what specific provisions she was talking about, if any. The term has since been used by some conservatives to refer to provisions of the law that promote medical research comparing the effectiveness of various procedures and medicines. Recently, conservative authors - but only a handful of Republican lawmakers - have started applying the term to the IPAB.
Rep. Henry Waxman (Calif.), the top Democrat on the full committee, said the IPAB was nothing more than a useful "backstop" to impose some "discipline" on Congress to avoid out-of-control Medicare health spending.
"We all hope the IPAB will be irrelevant. If the act works … it will be," he said. "Let's recognize today's vote for what it is: an attempt to discredit the Affordable Care Act and embarrass the president."
And Rep. Lois Capps (D-Calif.) said she favors getting rid of the board but wouldn't because the repeal bill offered no alternative for controlling Medicare costs and because it wasn't paid for.
This story was updated at 2:35 p.m.