The Washington PostDemocracy Dies in Darkness

The Health 202: Republicans kill Obamacare's controversial "death panel"

with Paulina Firozi


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: 

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.): 

From the conservative Independent Women's Forum: 

A helpful Kaiser Family Foundation explanation of what IPAB was supposed to do:

Kaiser Health News's Julie Rovner noted repealing the IPAB costs money for Congress:

CQ Roll Call's Mary Ellen McIntire:

Center for American Progress Action Fund's Igor Volsky: 

Bloomberg's Steven Dennis: 


AHH: CVS is the latest in a string of companies to announce wage hikes because of the Republican tax overhaul. The drugstore chain and pharmacy benefits manager said yesterday it will use the tax savings to invest $425 million annually to raise its minimum wage for hourly employees to $11 an hour and offer a paid parental leave program, Reuters reports. Half the savings will go toward debt reduction and at least $275 million will go toward strategic investments in its business, the company added.

“With $1.2 billion in cash benefits from the Tax Cuts and Jobs Act, we will be able to make strategic investments in our business in 2018 to stimulate greater growth over the longer term,” chief financial officer David Denton said in a statement.

OOF: Should the pharmaceutical industry be viewed as a partner or an adversary in fighting opioid abuse? That question is being raised by findings that the Pharmaceutical Research and Manufacturers of America (PhRMA) has donated to the Addiction Policy Forum, an anti-addiction advocacy group, and appearances by the group's leader Jessica Hulsey Nickel with drug industry lobbyists, the New York Times reports.

"PhRMA’s donation to Ms. Nickel’s group is roiling the anti-addiction world — where there are varying approaches to the drug problem and a fight over scarce sources of funding," Michael Corkery and Katie Thomas write. "The partnership with Ms. Nickel also sheds light on the industry’s efforts to shape the perception of its role in the nation’s burgeoning opioid epidemic, which President Trump has called a 'national health emergency.' By enlisting a prominent advocate as a partner, PhRMA is trying to position the industry on the right side of a health crisis that many blame it for creating."

“You cannot hold an organization accountable if they are paying your bills,” said Lexi Reed Holtum, executive director of the Steve Rummler HOPE Network, which advocates on addiction issues in Minnesota. 

OUCH: Four nonprofit groups stopped receiving U.S. aid funding in the past six months because of abortion restrictions enforced by the Trump administration, according to a report released yesterday by the State Department. State didn't name the four groups, but International Planned Parenthood Federation and Marie Stopes International were among them, according to a statement from Planned Parenthood.

When taking office last year, Trump reinstated the so-called "Mexico City Policy" -- which prohibits organizations that provide or promote abortions from getting U.S. aid dollars -- and extended it further to include all health-care funds, not just those designed for family planning. While four groups lost funding, 733 organizations received funding totaling $8.8 billion, according to the State Department report.


--In his 2019 budget plan to be released next week, President Trump will propose lowering prescription drug costs for seniors by allowing Medicare enrollees to share in rebates drug companies pay to insurers and middlemen, the AP reports. That's among eight proposals aimed at lowering drug costs to be included in the budget, according to a list The Health 202 obtained last night. They include expanding Medicare's “catastrophic” drug benefit to free seniors with very high costs from co-payments, ending misclassification of generic drugs in Medicaid and ending the 180 day exclusivity period for parked generic drugs.

“The president is firmly committed in this space,” Health and Human Services Secretary Alex Azar told reporters in a briefing yesterday. “I am now less than two weeks on the job and have been working a great deal, let’s just say, on these issues already. We do think drug prices are too high.”


--Our colleague Ben Terris examines the low profile Ben Carson has kept nearly a year into his role as secretary of Housing and Urban Development. The acclaimed neurosurgeon-turned-politician is overseeing an agency for which he is not particularly qualified and while he sought an opportunity to “clean up the swamp,” he “finds himself swimming in ethically murky water," Ben writes. More on that here.

--A few more good reads from The Post and beyond:


Five major psychiatric diseases have overlapping patterns of genetic activity, new study shows (Amy Ellis Nutt)

Insulin quality questions have diabetes experts scrambling (Associated Press)


U.S. FDA approves Gilead triple HIV drug, rival files lawsuit (Reuters)

Doctors at the Olympics work for years to get to the games (Stat News)


Judge suggests drug-addicted woman get sterilized before sentencing, and she does (Tom Jackman)


Don't overhype the new health care venture (Drew Altman)



  • George Mason University’s Law and Economics Center holds an event on generic drugmakers.

Coming Up

  • Kaiser Health News holds a discussion on living well with dementia on Feb. 13.  


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