Now Congress has killed a part of Obamacare that never even got to live except in the realm of political theater.
After years of GOP bluster about a Medicare cost-cutting tool — known as the Independent Payment Advisory Board, or IPAB — lawmakers quietly erased that deeply controversial part of the Affordable Care Act in a broad federal spending plan that passed both chambers of Congress while we were sleeping last night. The massive budget deal, which hikes military and domestic spending by hundreds of billions of dollars, passed the House at 5:30 a.m., nearly four hours after the Senate cleared the legislation, my colleagues Mike DeBonis and Erica Werner report.
The IPAB is the second part of President Obama’s health-care law this current Congress has kicked out the door, and unlike the individual mandate — recently unwound by the partisan GOP tax overhaul — many Democrats are on board this time around, but mostly because they’re supporting the larger spending framework.
Yet nobody’s exactly crying as IPAB takes a bow.
Even the most earnest ACA defenders have admitted it was mostly a gimmick to help pay for the health-care law and never held any real promise for reining in Medicare spending. It would have been the job of the panel, made up of outside experts, to recommend Medicare savings to Congress (almost certainly through payment cuts to doctors). But the program’s spending growth never hit a designated threshold so the panel was never even formed.
The Post's Glenn Kessler:
So the Independent Payment Advisory Board is dead? Not that it ever actually lived in the first place......— Glenn Kessler (@GlennKesslerWP) February 7, 2018
For their part, Republicans have long since wrung out all the political capital they were going to get from the IPAB — and wring, they did. If the mandate to have health coverage was the mother of all Obamacare controversies, the IPAB was at one time the grandmother of all Obamacare controversies.
Recall the hysteria over “death panels,” that infamous and terribly misleading descriptor coined by former vice presidential candidate Sarah Palin, who contended the panel would lead to the rationing of care (even though the panel had no say over what services Medicare covers). Palin’s claim, which GOP candidates widely adopted to strike emotional chords with voters, was chosen by PolitiFact as its “Lie of the Year” back in 2009.
As recently as 2016, 29 percent of Americans still believed this widely debunked claim, according to Public Policy Polling.
That’s not to say Republicans and conservatives didn’t have legitimate concerns about IPAB. It ceded some power to an unelected board even though Medicare is a program passed and overseen by Congress.
And as we outlined above, there was little practical reason to believe lawmakers would even go along with its recommendations, since politicians have shown time and time again they don’t have the political will to cut Medicare spending over the fierce objections of seniors and the massive health-care industry. Those are all reasons why, in the end, Democrats agreed to play ball with Republicans who have long desired to strike IPAB from the books forever.
As we did when the individual mandate was repealed, The Health 202 asked several health-care experts to offer their own eulogy to the IPAB. Here’s what they shared:
Joe Antos, health-care scholar at the American Enterprise Institute:
“The big problem with repealing the IPAB is this is a Congress — and it’s bipartisan — that has no interest in fiscal responsibility. It was only put in to produce savings, but there was never any intention from the very beginning to actually allow it to operate. It was a lot like many of these automatic savers in the Medicare program — they were never really meant to work. This was never going to get off the ground and so the point of this was really a fraud to begin with, which was to claim this was a way of paying for the ACA.”
Tim Jost, health law professor at Washington and Lee University:
“The [IPAB] was one of the most unpopular creations of the [ACA]. It was certainly the most misunderstood — claims that it created a death panel were simply fake news. It was also, however, wholly unrealistic — the idea that 15 of the top health care experts in the country would serve on such a panel for six-year terms on civil service salaries without outside compensation was ridiculous, as was the thought that Congress would simply go along with their recommendations.”
Gail Wilensky, former chair of the Medicare Payment Advisory Commission:
“I strongly support strategies that would slow the spending on Medicare, but the IPAB was not one of them for several reasons. First, it only focused on provider spending rather than the larger set of options, such as benefits, structure and eligibility, that could reduce spending on Medicare. Second, the decisions would essentially be made by a group of individuals that once appointed and confirmed had no accountability to anyone … IPAB is too much of a delegation of legislative responsibility to an unaccountable group of individuals.”
Rodney Whitlock, former health-care policy director for Sen. Chuck Grassley (R-Iowa):
“I was always offended by it. An august body makes decisions that the legislature is incapable of doing, but it was written in such a manner as to guarantee a certain outcome: provider cuts. Thus providers banded together to kill it from the start. They made it so radioactive it was never launched. Today (and that’s a bit of an assumption) is finally reading the last rites.”
Paul Van de Water, senior fellow at the Center on Budget and Policy Priorities:
“Repealing the [IPAB] is a case study of how hard it is to control health-care costs. Provider groups lobbied against IPAB under the guise of protecting seniors, when they were really protecting their own income. In fact, the law specifically prohibited IPAB from rationing health care, raising Medicare’s premiums or cost sharing, cutting benefits, or restricting eligibility. Now the Republican Congress is even more likely to consider blunt proposals to reduce Medicare spending by shifting costs to beneficiaries.”
Sen. Richard Shelby (R-Ala.):
I'm encouraged by today’s budget agreement, which would provide our military the resources needed to keep America safe. It's critical that we invest in our defense, our veterans, disaster relief, infrastructure, & combatting opioids. I also support repealing IPAB from Obamacare.— Richard Shelby (@SenShelby) February 7, 2018
From the conservative Independent Women's Forum:
Years after the Affordable Care Act's passage, the Independent Payment Advisory Board (#IPAB) remains deeply troubling to many Americans. Survey shows that Republican voters overwhelmingly favor repealing it. https://t.co/IffvZ2fVUL— IWF (@IWF) February 8, 2018
A helpful Kaiser Family Foundation explanation of what IPAB was supposed to do:
The proposed budget compromise in the Senate would repeal the #ACA's Independent Payment Advisory Board. Here are our FAQs from last fall which explain how #IPAB was designed to operate and the implications of eliminating it. https://t.co/9Y1AZ2KKhz #Medicare— Kaiser Family Foundation (@KaiserFamFound) February 8, 2018
Kaiser Health News's Julie Rovner noted repealing the IPAB costs money for Congress:
CQ Roll Call's Mary Ellen McIntire:
To clear up confusion from yesterday, IPAB repeal in budget deal would increase the deficit by $17.5 billion over a decade, per CBO— Mary Ellen McIntire (@MelMcIntire) February 8, 2018
Center for American Progress Action Fund's Igor Volsky:
It's also ironic that the very same lawmakers who complain about "out-of-control entitlement spending" ALL THE TIME...are about to vote to repeal the Independent Payment Advisory Board, which was designed to keep Medicare spending growth from rising above a certain level. https://t.co/Q18C5KkHpC— igorvolsky (@igorvolsky) February 8, 2018
Bloomberg's Steven Dennis:
There are some offsets in this deal, including Medicare, but there's also more Medicare spending by nuking IPAB, whose enactment was a triumph for the budget hawk wing of the Dems back in the day.— Steven Dennis (@StevenTDennis) February 8, 2018
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