Pressure is on Senate after House kills healthcare law's ‘rationing board’

The Senate is under increasing pressure to bring up legislation repealing a key part of President Obama’s healthcare law.

A House subpanel on Wednesday easily approved a measure to repeal a Medicare cost-cutting panel derided by Republicans as a “rationing board.” Two Democrats — including the panel’s ranking member — crossed the aisle and joined Republicans in voting to nix the Independent Payment Advisory Board (IPAB).

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The lopsided 17-5 vote underscored the bipartisan support for repealing the board, which Obama has made the centerpiece of his efforts to reduce Medicare spending. It also provided evidence the legislation could have a shot at passing the Senate.

Sen. John Cornyn (R-Texas) pounced after the House panel’s vote, arguing it’s time for Senate Majority Leader Harry Reid (D-Nev.) to bring up his version of the repeal bill.

“Given the bipartisan support in the House for repealing the IPAB, Sen. Cornyn is hopeful his Democrat colleagues in the Senate will support his bill,” Cornyn spokesman Drew Brandewei said. 


No Senate Democrats had signed on as co-sponsors of Cornyn’s bill as of Wednesday, but many in the party would be in a tight spot if it came to the floor. 

A spokesman for Sen. Claire McCaskill (D-Mo.), who is facing a tough reelection race, said the senator would take a “hard look” at the proposal if it ever came before the Senate. 

Calls about the repeal bill to the offices of vulnerable Democratic Sens. Jon Tester (Mont.), Joe Manchin (W.Va.) and Sherrod Brown (Ohio) were not immediately returned by press time. 

The Medicare board is central to Obama’s healthcare reform law because it’s one of the few provisions aimed at reining in federal health costs. Far from endorsing its repeal, the president actually proposed strengthening the board’s powers last year. 

“Former [Congressional Budget Office] Director Robert Reischauer called IPAB a ‘big deal’ that ‘could generate substantial savings,’ ” White House Deputy Chief of Staff Nancy Ann DeParle wrote in a blog post ahead of Wednesday’s Energy and Commerce Health subcommittee vote. “Hundreds of prominent economists, including three Nobel Laureates, agree that IPAB is an important component of the Affordable Care Act that will slow healthcare cost growth.”

The provision in the health law that established the Medicare panel originated with Sen. Jay Rockefeller (D-W.Va.) and was never popular in the House, where 17 Democrats are among the repeal bill’s 226 co-sponsors.

As a result, the bill is expected to sail through the House, where a Republican leadership aide told The Hill the goal is to pass it in conjunction with Supreme Court arguments on the health law’s constitutionality.

The House took its first step toward that goal with Wednesday’s vote, in which ranking member Frank Pallone Jr. (D-N.J.) and Rep. Edolphus Towns (D-N.Y.) joined Republicans to vote for repeal.

Chairman Joe Pitts (R-Pa.) opened the repeal markup by arguing that the 15-member board would supplant lawmakers’ ability to shape 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 vote or block the panel’s recommendations with a supermajority.

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.

Pitts, however, pointed out the term “rationing” is not defined anywhere in the law.

“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 to seniors.

“Last year,” Pallone 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.”

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 stop 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.”