House Democrats say Obama's Medicare board should be put on the table

The healthcare law's controversial Medicare board should be on the table in deficit-reduction talks, House Democrats said this week.

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Killing the Independent Payment Advisory Board (IPAB), which Sarah Palin decried as a "death panel" in June, could ease Republican concessions as part of a year-end deficit deal, Dems said.

"I think everything has to be on the table," said Rep. Dan Boren (Okla.), one of healthcare reform's most consistent Democratic opponents.

"Anything that could help along the way to get some agreement," said Rep. David Scott (D-Ga.).

IPAB is one of the most-hated parts of President Obama's signature healthcare reform law and remains a major target for the GOP.

Created to reduce Medicare spending, it would cut the program's reimbursement rates when per-capita outlays become too great.

Conservatives have long wanted to repeal the 15-member board, arguing that its design is undemocratic, since the panel's decisions would take effect unless Congress blocks them.

Opponents also say the board would encourage de facto rationing within Medicare by limiting provider payments.

These arguments are not exclusive to the right.

Scott voted for a bill to repeal IPAB along with six other Democrats in March, less than half of the Democrats who signed on as cosponsors to the original repeal bill.

That measure, from Rep. Phil Roe (R-Tenn.), had at least 20 Democratic supporters, including liberals such as Rep. Barney Frank (D-Mass.).

In the end, IPAB repeal was offset by medical tort reform, which cut down on the vote's backing from outside the GOP.

Frank slammed GOP leadership as "irresponsible" for combining the two, which alienated Democrats.

"They talk about wanting to have bipartisan cooperation but they don't want it," Frank said in March.

"They're taking two very different issues and putting them together in an effort to coerce Democrats … This is nothing more than an overreach to appease the right wing."

With about two weeks until Jan. 1, it remains to be seen whether Obama and Speaker John Boehner (R-Ohio) can hammer out a deal to avoid the "fiscal cliff."

Democrats have been successful in taking many entitlement reforms off the negotiating table, including Medicaid cuts and, possibly, raising Medicare's eligibility age.

But putting IPAB on the chopping block would come with its own set of challenges.

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Repealing the board would mean gutting its Medicare savings, creating the need to find equivalent cuts elsewhere — $3.1 billion over 10 years, according to the Congressional Budget Office.

Democrats said that adding IPAB to talks could still bring the parties together as they confront the spending cuts and tax hikes set to take effect in January.

"We've got to look at everything. There is no sacred cow. Even though Congress has passed the healthcare bill, we've got to look at everything," Boren said.

Scott agreed, calling it a "win-win."

"There is something there for everybody … That's something where Republicans gain a little bit."

He described his opposition to IPAB, which bars members from having outside employment.

"If we're going to look at Medicare to get savings, and you eliminate having any existing, practicing physicians on the board to help determine how we get these savings, you're losing an opportunity," Scott said.