“Here’s the problem I have with the Affordable Health Care Act. Number one, there is a provision in there that anyone over the age of 74 has to go before what is effectively a death panel.”
— Local GOP official Bill Akins, at a town hall in New Port Richey, Fla., Feb. 11, 2017

Bill Akins achieved his 15 minutes of fame — and, he says, death threats — after a clip of him making this statement at a Florida town hall went viral. The audience immediately hooted him down, and he responded by saying, “Okay, children. All right, children.”

In 2009, former Alaska governor Sarah Palin first promoted the idea that the emerging law contained death panels, referring to a provision that would allow Medicare to pay for doctor’s appointments for patients to discuss living wills and other end-of-life issues. Her Facebook post making this claim ignited a firestorm that resulted in the language being removed from the final legislation. In 2011, the Obama administration even deleted all references to end-of-life planning in a new Medicare regulation when opponents interpreted the move as a backdoor effort to allow such planning.

Since the death-panel issue supposedly had been eliminated, the Fact Checker reached out to Akins to find out why he thought it was still relevant. He responded that he had conflated two pieces of information, and so had bungled his comment. Here’s what he says he was trying to say.

The Facts

Akins spoke up at a town hall event hosted by Rep. Gus M. Bilirakis (R-Fla.). Akins said the session had been packed with Democrats, eager to confront the lawmaker over plans to repeal Obamacare. Akins, who is secretary of the Pasco County Republican Executive Committee, rose to pose his own question. He said he was not speaking as a GOP official, but identified himself because others at the meeting had given their political affiliations. He now says that was a mistake, in part because “I think it closed some ears.”

When he referred to a death panel, Akins said he was actually talking about something in the law called the Independent Payment Advisory Board (IPAB). The IPAB, to be made up of 15 experts appointed by the president and subject to Senate confirmation, is primarily charged with helping to reduce the rate of growth in Medicare spending.

But the IPAB would be formed only by a triggering condition — when the projected five-year Medicare per capita growth rate exceeds the targeted Medicare per capita growth rate. Even though the law was signed in 2010, President Barack Obama never appointed any board members because that condition was not met.

Akins said he was concerned that, in the absence of an appointed board, the power would rest with the secretary of Health and Human Services, and he wanted Bilirakis’s assurance that it would not be used to create death panels. (The new HHS secretary is former congressman Tom Price (R-Ga.), a longtime foe of the law.)

But Akins never got to ask his question because of the uproar. (Bilarakis interjected that Akins was referring to IPAB, and noted that he had voted in Congress to repeal the board.)

The IPAB has long stirred concern on the right. In 2011, the 60 Plus Association, a conservative senior citizens’ group, launched a $3.5 million ad campaign featuring singer Pat Boone falsely charging that “this IPAB board can ration care and deny certain Medicare treatments.”

The IPAB actually appears to mimic the Defense Base Closure and Realignment Commission, which was designed in the late 1980s by then-Rep. Richard K. Armey (R-Tex.) with the backing of the Reagan administration. That commission was empowered to make politically difficult decisions of closing military bases, thus limiting the influence of lobbyists and in effect letting Congress off the hook in making the tough decisions.

Similarly, if Medicare spending targets are not met, IPAB would submit a plan to the White House and Congress to achieve the necessary program cuts. Congress could pass a different set of cuts or reject the IPAB recommendations with a three-fifths vote in the Senate.

In the interview, Akins acknowledged that the health-care law explicitly says that the recommendations cannot lead to rationing of health care. (See page 428.) But he believed such guarantees were worthless, ticking off other examples of when Congress later changed its mind. “IPAB is like a little ticking time bomb,” he said. “I don’t want there to be death panels.”

But given that he was concerned about the IPAB — which has not yet been formed — why did Akins make a reference to age 74?

“That’s the one mistake I made,” Akins said. “I was conflating information.”

He said he was referring to a provision in the law in which the ACA was advising doctors that some medical procedures were no longer necessary after a certain age. “I read the age 74 in one article,” he said. “I confused the testing that can no longer be done with the actual IPAB. It was an understandable conflation.”

But Akins is wrong about this. The ACA does not limit medical tests, and actually mandates coverage for basic preventive tests. The number of tests you might receive really depends on the insurance coverage you buy and doctors’ recommendations.

We suspect that Akins is referring to claims in a viral email that circulated in 2009 that included claims such as, “At age 76 when you most need it, you are not eligible for cancer treatment [see] page 272.”

The email was based on a letter to the River Cities Tribune (circulation 5,000), written in August 2009, by a former county judge named David Kithil of Marble Falls, Tex. Back in 2011, he told the Fact Checker that he had assessed an earlier version of the law and that some of his concerns had been addressed. In any case, Kithil is not a health-care expert and many of his claims have long been debunked.

Yet here we are, eight years later, and a variation of Kithhil’s inaccurate claims turns up in a viral video.

The Bottom Line

The dispute over the IPAB centers on a philosophical divide between the two major parties. Democrats would rely on independent experts (such as doctors and consumer advocates) to recommend the cuts; Republicans, through the Medicare plan advanced by House Speaker Paul D. Ryan (R-Wis.), would rely on the insurance marketplace to control costs. We cannot fact check deeply held philosophical beliefs, except to note that such differences sometimes loom larger than they really are and prevent people from acknowledging obvious similarities in their ultimate goals.

But using inflammatory language such as “death panels” — and recycling claims from eight years ago — serves to only heighten the divide.

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"There is a provision in there that anyone over the age of 74 has to go before what is effectively a death panel.”
at a town hall in New Port Richey, Florida
Saturday, February 11, 2017