Politics & Policy

IPAB Under Fire

Some Democrats are souring on the centerpiece of Obama’s Medicare reform.

House Republicans spent the Easter recess among their constituents explaining and defending the recently adopted budget resolution authored by House Budget Committee chairman Paul Ryan (R., Wis.). Much of the conversation centered on what is by far the most controversial aspect of the plan: Medicare reform. Ryan plans to salvage the soon-to-be-insolvent health-care entitlement for seniors by transitioning to a “premium support” model that empowers consumers to choose among competing private plans.

Meanwhile, congressional Democrats jumped at the opportunity to accuse Republicans — however falsely — of “voting to end Medicare.” They shouldn’t get too comfortable, however, because Democrats may soon be forced to weigh in on President Obama’s alternative to Ryan’s reforms, namely the Independent Payment Advisory Board (IPAB), a 15-member panel of “experts” that would be tasked with “improving” Medicare by “finding savings” in the program — which many fear is simply code for rationing (remember “death panels?”). In his speech at George Washington University, Obama doubled down on IPAB as his primary means of confronting rising Medicare costs, recommending that it be granted additional “tools” and “enforcement mechanisms” to control costs and that its creation (scheduled for 2014 under the new health-care law) be fast-tracked.

“All we’re saying is if we’ve got health-care experts — doctors and nurses and consumers — who are helping to design how Medicare works more intelligently, then we don’t have to radically change Medicare,” Obama said at a recent town-hall event organized by Facebook.

In fact, some Democrats have already begun to weigh in against the idea. Rep. Phil Roe (R., Tenn.), who introduced a bill in late January to repeal IPAB, currently has more than 80 cosponsors, including a number of Democrats. Most recently, Rep. Allyson Schwartz (D., Pa.) sent a letter “strongly” urging her colleagues to support repeal, describing IPAB as a “flawed policy that will risk beneficiary access to care.”

“Congress is a representative body and must assume responsibility for legislating sound health care policy for Medicare beneficiaries, including those policies related to payment system,” Schwartz wrote. “Abdicating this responsibility, whether to insurance companies or an unelected commission, would undermine our ability to represent the needs of the seniors and disabled in our communities.”

She joins others Democrats from across the ideological spectrum, such as Reps. Pete Stark (D., Calif.), Shelley Berkley (D., Nev.), Michael Capuano (D., Mass.), and Larry Kissell (D., N.C.), a conservative blue dog, in support of repeal. But Schwartz is a health-care-reform champion and vice chairwoman of the New Democrat Coalition, which makes her the most prominent Democrat to oppose the president’s plan and gives Republicans like Roe reason to believe that his repeal bill has a shot to pass both chambers. At the very least, it would appear that Obama’s plan to strengthen IPAB is dead on arrival.

In fact, IPAB’c creation was never formally supported by the Democratic House. The panel was included in the Senate’s version of the health-care bill only at the last minute, lost in the flurry of negotiations during the controversial reconciliation process used to pass the bill. Before that, in January 2010, more than 70 House Democrats signed on to a letter opposing the inclusion of the board. Representative Stark at the time called IPAB a “dangerous provision” that would make “unsustainable cuts” to Medicare based on “an arbitrary and unrealistic growth rate.” Even Rep. Henry Waxman (D., Calif.), a close ally of Minority Leader Nancy Pelosi, expressed reservations about the board’s creation and recently indicated that he could be open to its repeal.


Roe, a physician, tells National Review Online that since the beginning of the debate over health care, he has been researching the ins and outs of single-payer health systems. He notes that Great Britain has a health-care board comparable to IPAB, known as the National Institute for Health and Clinical Excellence — or NICE. He says boards like these serve only to undermine the quality and even the availability of patient care. For instance, in a recent decision, NICE denied approval for a breast-cancer drug that helps treat late stages of the disease, prolonging the life of the patient by an average of ten weeks. NICE deemed this benefit insufficient to justify the cost of the drug. “This is the kind of things that awaits us with IPAB,” Roe says. “If care is going to be rationed, and I think it is in some kind of way, should it be done by government bureaucrats or should it be patients who get to decide?”

Meanwhile, Republicans, led by Paul Ryan, have started to defend their own proposals by presenting voters with a choice between competing visions of how to confront Medicare costs. If Medicare is to be preserved for future generations, Ryan explained at town-hall meetings over the recess, the alternative to the GOP’s premium-support model is not, as some suggest, to simply “tax the rich more,” but rather is exactly what the president has proposed with IPAB.

Roe says that, with the number of serious issues confronting Congress at the moment, he’s had to work diligently to spread the word about his repeal effort, often grabbing individual members on the House floor to discuss. “The problem with this issue is that it’s a very hard issue to discuss in a one-minute sound bite,” he says. “We started out with only ten or twelve cosponsors, but we had ten people sign up the day of Obama’s speech. The more he talks about it, the more people sign up.”

As for the Democratic cosponsors of his bill, Roe says: “We may have disagreed on the health-care law itself, but we agree on this.” He expects more will come forward in the weeks ahead.

— Andrew Stiles is a 2011 Franklin Fellow with National Review Online.

Andrew StilesAndrew Stiles is a political reporter for National Review Online. He previously worked at the Washington Free Beacon, and was an intern at The Hill newspaper. Stiles is a 2009 ...


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