Republicans have had no luck convincing Democrats to adopt their controversial plan to convert Medicare into a subsidized private insurance system. But they have had some success convincing Democrats to abandon President Obama and his plan for making Medicare spending sustainable. At least until now.
With help from some Democrats, House committees last week cleared legislation that would repeal the Independent Payment Advisory Board (IPAB), the Medicare cost-saving board created by Obama’s health care law, and the GOP-led chamber is poised to pass it next week. But their new plan to pay for the bill with a medical malpractice reform measure is already costing them Democratic votes — and thus weakening their claim that Obama’s vision for Medicare faces bipartisan opposition.
It’s the latest jab in the congressional shadowboxing over Medicare’s future.
Republicans are still trying to erode support for Obama’s Medicare plan — one that preserves the program’s single-payer benefit structure — and to build consensus around their competing plan to provide seniors capped subsidies to buy private insurance. So far they’ve had more luck with the former. Now they’re putting their early gains on the line.
“Unfortunately, Republican leadership is manipulating the dialogue on this issue for political purposes, which will undoubtedly lead many Democratic members to vote against the bill — despite support for the underlying policy from House Democrats across the ideological spectrum,” Rep. Allyson Schwartz (D-PA), the most outspoken Democratic opponent of Obama’s Medicare panel, told TPM. “By unnecessarily tying repeal of IPAB to a partisan malpractice bill, House Republicans have effectively ensured that this bill is dead. This is deeply disappointing.”
Rep. Barney Frank (D-MA), another signatory of IPAB repeal, told TPM the GOP lost his vote with the tort reform pay-for — and predicted other Dems will bolt, too. “It’s typical of their irresponsible approach,” Frank said in an interview Monday. “They have a lot of Democratic support to repeal [IPAB] and they know it. They were dangerously close to having some bipartisanship and they couldn’t accept that.” He said the two measures are unrelated and decried the move to link them “an overreach to appease the right wing.”
House GOP leaders decided to fund the $3.1 billion cost to repeal IPAB with Rep. Phil Gingrey’s (R-GA) malpractice reform bill, which is a poison pill for most Democrats and even some key Republicans. It’s an indication that the GOP has given up on getting a bill to Obama’s desk, where he’d probably veto it anyway. The House will nevertheless hold a floor vote on it next week, a leadership aide told TPM.
The White House, which has recently stepped up its defense of IPAB, expects the repeal bill to stall in the Senate. There, the GOP has failed to win a single Democratic cosponsor — and the House pay-for makes failure even more likely in the upper chamber.
Sen. John Cornyn (R-TX), the sponsor of the Senate’s IPAB-repeal legislation, acknowledged he doesn’t have a Dem signatory yet. “We’re working on that,” he told TPM last week. Does he expect to find any? “I certainly would hope so, because this is not a partisan issue. This is a question of whether Congress is going to delegate its authority to unelected, unaccountable bureaucrats to set prices for health care providers.”
Kathleen Sebelius, secretary of Health and Human Services, paid a visit to Capitol Hill Thursday to talk Democrats out of voting to repeal IPAB. White House senior policy adviser Nancy-Ann DeParle has also been reaching out to Dem members to make the case for the panel, which is charged holding down Medicare spending on provider payments. No matter, Dems are resigned to IPAB repeal passing the House — they did not request roll call votes as it was approved by the Energy & Commerce and Ways & Means committees on voice votes.
The strong GOP and health care industry push for IPAB repeal suggests that winning conservative Dem support in the Senate might have been feasible. The fact that liberals like Reps. Frank Pallone (D-NJ) and Frank, along with conservatives like Rep. Mike Ross (D-AR), support IPAB repeal creates easy cover for industry-friendly Democratic senators. And while it’s possible they’ll ultimately join the GOP’s efforts, it’s clear that Senate Dems broadly aren’t as troubled by IPAB as their House counterparts. By tying a medical malpractice measure to their efforts, House Republicans have made winning over Senate Dems that much harder.
If it survives, IPAB, which was conceived in the upper chamber, will constitute 15 Senate-confirmed health care experts tasked with cutting Medicare spending if per-beneficiary spending growth exceeds per-capita GDP plus 1 percent. Congress could only override those cuts by passing alternative legislation to save the same amount of money. Many House Dems are uncomfortable ceding this jurisdiction to an outside panel.
House Minority Whip Steny Hoyer (D-MD) conceded that there’s some discomfort with IPAB among House Dems. “There were a number of Democrats who signed onto [the GOP] bill because they believe it ought to be Congress’ responsibility to [address Medicare costs],” he told reporters last week. “I think that’s a legitimate perspective.” But, Hoyer said, “IPAB is not going to pass the Senate even if it passes the House, and if it did the president would veto it. The president feels very strong about this as a cost controlling measure.”
Part of the reason the White House wants to limit defections is that officials see the GOP’s IPAB-repeal push as a political gambit to pick apart the Affordable Care Act, and don’t want to convey a sense of Democratic skittishness on Obama’s signature domestic achievement. Far from dialing down his commitment to the panel, Obama has proposed lowering its upper-limit spending growth cap to GDP plus 0.5 percent.
Republicans view IPAB as a unique opportunity to enlist Dems to the cause of weakening the health reform law while also currying favor with the health care industry, which is dead set on killing IPAB. At the same time, smothering IPAB in its cradle serves the broader GOP goal to create a sense of inevitability that Medicare cost-growth requires moving to a voucher system, as proposed by its top budgeter, Rep. Paul Ryan (R-WI).
If Republicans fail to repeal IPAB, they have a fallback option: Block anybody from being confirmed to the panel, which is slated to begin its work in 2014. Senate Republicans have suggested they’ll embrace that option, and they’re all but certain to have the votes to filibuster any of Obama’s nominees.
There is another possibility: that neither IPAB nor privatization will be necessary to save Medicare. New research finds that costs-control policies, most notably in the Affordable Care Act, could help hold down long-term Medicare spending enough that IPAB will be functionally moot. The falling cost curve is one reason the Congressional Budget Office deemed IPAB repeal to cost only $3.1 billion after it was projected to save $15 billion.
Sahil Kapur is a congressional reporter for TPM. He previously covered politics and public policy for numerous publications including The Guardian and The Huffington Post. He can be reached at sahil [at] talkingpointsmemo.com.