Shortly before the Supreme Court could invalidate Obamacare subsidies in most states, House members rolled back into town for a Tuesday evening vote to abolish “death panels.”
Well, that’s the phrase Sarah Palin used. It might not be accurate in any direct or literal sense, but it has stuck around in Washington’s vocabulary for the last six years, a wry in-joke about the absurdity of the Obamacare debate.
Of course, not everyone feels that way. House Republicans have the votes to pass their bill repealing the Medicare cost-cutting board known as IPAB (that’s “Independent Payment Advisory Board”). It’s a body charged with recommending ways to cut payments to doctors who accept Medicare patients in order to prevent federal healthcare costs from spiraling out of control over time.
The panel exists only on the books at this point. The slow economy — and the Affordable Care Act, the administration argues – have kept Medicare cost growth at a record low. Without a need for its work, the IPAB will never convene.
Still, Republicans want to make sure they’re on the record against the “death panel.”
Not many lawmakers rely on the phrase in their rhetoric now that it’s meaning, shaped and reshaped by Palin, has been debunked. But underneath the doomsday image is a bookish debate in which Republicans are anxious to lay a marker.
Like most legislative fights over the healthcare law, the tussle over IPAB has little potential to change the status quo before President Obama leaves office.
Repealing the board also seems to go against Republicans’ fiscal principles, at least superficially. The board is designed to reduce federal spending, and congressional budget analysts say repealing it would cost $7.1 billion over ten years. (GOP lawmakers are paying for Tuesday’s bill with cuts to a separate Obamacare account.)
The GOP makes two arguments in defense of its repeal campaign, one practical and one academic.
The first is about the elderly. Republicans argue that cutting Medicare payments would eventually hurt senior citizens by making doctors less likely to offer care through the program. Fewer doctors, fewer healthy seniors, the argument goes.
“All this thing has done, it is designed to basically go around Congress, go around the laws, and have unelected and unaccountable bureaucrats ration care for our seniors,” said House Ways and Means Committee Chairman Paul Ryan (R-Wis.) on the House floor Tuesday.
The second nods to a belief among Republicans that the executive branch, led by Obama, is slowly eroding Congress’s authority.
Under the healthcare law, the IPAB’s recommendations would be fast-tracked through Congress. Lawmakers would have to vote down the recommendations or find equal savings elsewhere, lest the cuts automatically take effect.
This forms the basis for the more impassioned case against IPAB among conservatives.
Most are already incited by the conviction that Obama’s executive actions represent an unprecedented, illegal expansion of power at the White House.
Scholars might disagree, but with Republicans seeing political and historical upsides in defending their turf, a federal board that could cut Medicare payments is an easy target.
There are only a few more decision days before the Supreme Court rules in King v. Burwell, and Washington is full of skepticism that the justices will deal a major blow to the healthcare law.
Perhaps it is not surprising, then, that the House GOP seems to be shadow boxing with a possible future enemy.