Health reform implementation

Key Democrat testifies against healthcare reform bill’s Medicare cost-control panel

A key Democrat testified Wednesday against a major provision of the healthcare reform law that is intended to help control Medicare costs, but that Republicans have alleged will encourage “rationing” of care.

Rep. Allyson Schwartz (Pa.), the No. 2 Democrat on the House Budget Committee and a respected voice on healthcare policy issues, was invited by Energy and Commerce Committee Republicans to speak at a hearing on the law’s cost-control panel. She told The Hill that President Obama’s stated desire to beef up the Independent Payment Advisory Board (IPAB) in order to pare down Medicare costs “was one of the reasons I spoke out.”

“There are Democrats who also have concerns about the IPAB,” she said, “and that’s been true from the beginning. I would say on behalf of myself and Democrats who care about this as well, it would be better to repeal this part of the law.”

Obama in April proposed increasing the IPAB’s authority as an alternative to House Republicans’ Medicare overhaul. The president laid out a proposal he said would reduce the deficit by $4 trillion over 12 years, in large part by lowering the threshold when the IPAB kicks in Under the law, the IPAB issues recommendations that Congress must act on if the growth of Medicare costs exceeds a specific target.

Schwartz, a former healthcare executive and current vice president of the centrist New Democrat Coalition, is one of eight Democrats who have signed on to Republican legislation to repeal the provision. She said she spoke to the White House and fellow Democrats in Congress about her intention, and made it clear to them that she remains a strong advocate of the healthcare reform law.

“I [had] conversations with some of my colleagues and, by and large, they said I should state my position and a number of them shared my concerns,” she said.

Schwartz told The Hill that the top Democrat on the committee where she testified, Rep. Henry Waxman (D-Calif.), didn’t seek to dissuade her from testifying. She wouldn’t delve any deeper into private conversations, however.

“I did have conversations, because I wanted — and I continue to want to make absolutely clear that I do not agree with the Republican notion that this is rationing,” she said.

Indeed, Schwartz spent much of her testimony attacking the Republican proposal to replace Medicare with private insurance subsidies starting in 2022. She rejected the notion that the IPAB would ration care, but described it as a blunt instrument that could unintentionally weaken the healthcare law’s efforts to curb healthcare costs by blindly cutting payments to doctors and hospitals.

Still, it’s clear Republicans were delighted by her appearance.

“It certainly negates any accusations that this debate is a partisan scare tactic when members of President Obama’s own party are echoing our concerns that IPAB will result in significant cuts to health services and urging Congress to repeal the controversial board,” an Energy and Commerce staffer tells The Hill.

The White House had no comment about Schwartz’s appearance, but Health and Human Services Secretary Kathleen Sebelius testified Wednesday before the committee. 

“The nonpartisan Congressional Budget Office and the independent Medicare actuary both predict that the IPAB is unlikely to be necessary anytime soon thanks to the work we’re already doing to slow rising costs,” Sebelius said in written testimony. “But we can’t know the future, which is why experts across the country believe the IPAB is a needed safeguard.”

— Originally published at 4:23 p.m. and updated at 9:04 p.m.

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