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House Republicans Find Democratic Allies In IPAB Repeal Effort

Later this month, just as the Supreme Court is hearing arguments on the 2010 health law, the House is expected to pass a measure that would repeal an advisory board created in the law to curb Medicare spending if it exceeds specific targets.

But the debate is not shaping up like the usual House legislative fight over the law, where Republicans want to either strike a particular provision or repeal the whole thing and Democrats fight back to stop it.

Photo by Karl Eisenhower/KHN

Some key Democrats, such as Rep. Pete Stark, D-Calif., the ranking Democrat on the House Ways and Means Health Subcommittee, and Rep. Frank Pallone, D-N.J., the ranking Democrat on the House Energy and Commerce Health Subcommittee, want the Independent Payment Advisory Board (IPAB) gone. While they support the health law, they think the panel would transfer power that belongs on Capitol Hill to the executive branch.

President Barack Obama will nominate 15 people to serve on IPAB who are subject to Senate approval. If Medicare spending exceeds a certain target, the panel would make recommendations  to Congress on how to lower Medicare spending — but within certain constraints, including no increases in beneficiary premiums or cost sharing or cuts to benefits. Congress would have to consider those proposals on a fast-track basis, and if lawmakers disliked the proposals, they would have to pass alternatives that would achieve the same level of savings. If Congress fails to act, the secretary of Health and Human Services would have to implement the IPAB recommendations.

At a subcommittee hearing Tuesday, Stark said his beef was not with the health law but with the idea that Congress woudn’t be in control of Medicare spending. The law, he said, has extended Medicare’s solvency, slowed its spending growth and lowered beneficiary costs, among other benefits. “Congress has always stepped in to strengthen Medicare’s finances when needed. … I see no reason why Congress would or should hand that authority over to the executive branch. To do so undermines the separation of powers.”  And he reminded everyone that “the House included no such provision in our health reform bill.”

Pallone has expressed similar concerns. “For me, this is about Congressional prerogatives being limited.   IPAB, like other independent commissions, encroaches upon legislative authority,” he said last month.  “My vote in support of abolishing IPAB is not related to my support for the [health law].  In fact, I do not see IPAB as a significant factor.”

IPAB repeal legislation, sponsored by Rep. Phil Roe, R-Tenn., has 19 Democratic co-sponsors in the House, but companion legislation in the Senate, sponsored by Sen. John Cornyn, R-Texas, has no Democrats on board.  “We’re working on that,” Cornyn said.    The board has strong support from Obama and many Senate Democrats, including its chief backer, Sen. Jay Rockefeller, D-W.Va.