Independent Payment Advisory Board

Why Republicans Are Fighting To Repeal Obama's Medicare Cost-Cutting Board

Sahil Kapur | February 28, 2012, 5:29AM

House Republicans are poised to advance legislation this week to repeal President Obama's Medicare cost-cutting board, a provision enacted in the health care reform law. The Energy & Commerce Committee is set to mark it up this Wednesday, and the repeal bill already has enough cosponsors to pass the House. It's not expected to survive the Senate or Obama's veto pen, but the debate over this provision cuts to the heart of the battle over how to save Medicare in the long run.

Some background: The Independent Payment Advisory Board (IPAB) is set to take effect in 2014, and would comprise 15 President-appointed and Senate-confirmed experts charged with holding down Medicare per-beneficiary spending by restricting reimbursements to providers. It is forbidden from cutting payments to beneficiaries. Congress can override the panel is by passing an alternate way to save the same amount of money, or with a three-fifths Senate majority. The health care industry has been outspoken in its hatred for IPAB. Republicans are united in their effort to kill it, and even some House Dems are on that page.

The question now is: Why is the party that's hell-bent on reining in Medicare pushing to repeal this powerful tool for doing just that? Part of it is to score political points by slicing off a key piece of the Affordable Care Act. But more importantly, Republicans don't want to keep Medicare in its current form. Many of them don't think that's feasible. They want to transition it to a privatized model a la the Paul Ryan plan, where seniors get a fixed subsidy -- or "premium support" -- to buy their own insurance on a private exchange.

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Affordable Care Act

GOP Governors Face Quandary In Key 'Obamacare' Battle

Sahil Kapur | February 23, 2012, 5:48AM

Republican governors are caught between a rock and a hard place as they grapple with how to handle the state-based insurance marketplaces required by the health care reform law. The Obama administration announced Wednesday that 10 states will be getting federal grants to lay the groundwork for these exchanges -- four of the states have Republican governors, who have apparently decided to bite the bullet and proceed with building them.

Here's the predicament: The Affordable Care Act gives states the option to set up their own exchange by 2014 -- essentially a regulated marketplace where consumers can pool together to buy insurance plans that must provide a package of essential benefits. If states don't set up an exchange, the federal government would be required to take over. From a policy standpoint it's a no-brainer: take the money and use the flexibility to your advantage. But that's politically tedious because as GOP governors or heavily Republican legislatures can't be seen as abetting the law that conservatives hate, even if the fallback option would be less desirable on a substantive level.

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Birth Control

Birth Control Lawsuits Have Shaky Legal Merit

Sahil Kapur | February 22, 2012, 6:17AM

President Obama's religious accommodation in his rule requiring insurance plans to cover birth control has failed to placate elements of the Catholic community, and, with strong GOP support, they remain determined to sue. But do the lawsuits, the latest of which was filed Tuesday, have much legal merit? Possibly, but if judicial precedent is any indication, probably not.

The tweaked regulation says religious non-profits like universities and hospitals do not need to pay for free birth control coverage in their employee health plans, and can pass the cost on to the insurance company. (Churches and houses of worship are entirely exempt.) But like other entities, Ave Maria University, a Catholic institution, argues in a new legal challenge that affiliating itself with any access to contraception would violate its religious beliefs.

But barring a departure from precedent, the lawsuits aren't set to go very far.

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Affordable Care Act

Supreme Court Considers Delaying Health Care Ruling To 2014

Sahil Kapur | February 21, 2012, 11:45AM

The Supreme Court is poised to rule this summer on the constitutionality of the health care reform law's requirement that Americans buy insurance or pay a tax penalty. But it has the legal option to delay a decision until at least 2014, and although the possibility has received little attention, new evidence suggests that justices are considering it more strongly.

The temporary escape hatch involves the Anti-Injunction Act, an age-old law that says courts may not halt a tax that isn't yet being collected. (Under the Affordable Care Act, it won't be collected until 2014.) Although the Fourth Circuit Court of Appeals last fall tossed out a lawsuit against the mandate on this basis, most courts have decreed that the statute doesn't apply here.

But further evidence that justices may disagree came Tuesday, when the Supreme Court increased the time for next month's oral arguments from 5.5 hours to 6 hours, allotting an extra half hour to discuss the application of the Anti-Injunction Act. That means there will be a full hour and a half to discuss whether the court has the authority to rule on the health law this year.

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Affordable Care Act

GOP Snatches 'Obamacare' Cuts As Payroll Fight Wraps Up

Sahil Kapur | February 15, 2012, 6:25PM

While Democrats will claim victory in the impending deal to extend the payroll tax cut through 2012, Republicans have also won some fodder for their base on a key issue: They've managed to slice off a piece of the health care reform law -- albeit a fairly small piece.

A summary of the deal circulated to allies and insiders by House GOP leadership boasts that they've extracted concessions worth $11.6 billion from the Affordable Care Act in negotiations with Democrats. The cuts hit the prevention fund and provider reimbursements -- it's not a big chunk of the nearly $1 trillion law, but it's a salient political win for Republicans after Democrats repeatedly resisted efforts to cut the ACA in the Super Committee and December deal.

The Republicans may also have won on what could become an important matter of principle: whether savings from the projected wind-down of war spending could count as offsets. Democrats had wanted the cutbacks from the "Overseas Contingency Operation" (basically, the wars in Iraq and Afghanistan) to be able to be used as offsets for the so-called "doc fix." Republicans had been under immense pressure to cave on that as well. However, many argued that since these operations had been scheduled to wind down anyway, then they did not count as real savings. Furthermore, some feared that if they allowed this maneuver for the "doc fix" then Dems would try to use it to bankroll their pet infrastructure projects.

Here's the relevant except from the GOP-written Wednesday document, obtained by TPM and the numbers confirmed by Democratic and Republican leadership aides:

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Birth Control

Putting The Growing Birth Control Firestorm In Perspective

Sahil Kapur | February 6, 2012, 4:05PM

The Obama administration's requirement that health insurance plans cover birth control has provoked a full-blown Republican firestorm over religious liberty. But the policy itself carves out an exemption for churches and doesn't require any individual or employer to violate a religious belief -- it simply ensures that their employees with different beliefs have the same access to birth control as all other women.

The background: The Affordable Care Act provides that insurance companies cover certain preventive health services without copays. Last August, the Department of Health and Human Services drew upon recommendations from the Institute of Medicine and decided that birth control be part of that package. It said employer-based health care plans must cover contraceptive services without copays. The move received limited attention at the time.

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Birth Control

Boehner: Birth Control Mandate Is Unconstitutional

Sahil Kapur | February 2, 2012, 2:55PM

U.S. Speaker of the House John Boehner (R-Ohio) speaks to the press during his weekly press conference on Capitol Hill in Washington, D.C. on December 1, 2011.

As religious groups freak out over the Obama administration's contraception mandate, House Speaker John Boehner (R-OH) piled on by claiming that the policy is unconstitutional.

The mandate, authorized under the Affordable Care Act, holds that employer-provided health insurance plans must provide birth control to women without co-pays. Houses of worship are exempt, and religious nonprofits are allowed an additional year before they begin complying. But conservative religious organizations and their allies on Capitol Hill say that's not enough.

"I think this mandate violates our constitution," Boehner told reporters on Thursday. "I think it violates the right of these religious organizations. And I would hope that the administration would back up and take another look."

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CLASS Act

Long-Term Care On Life Support As House GOP Passes Repeal Of CLASS Act

Sahil Kapur | February 1, 2012, 7:06PM

Shutterstock /stefanolunardi

"Where is your heart?" cried Rep. Bill Pascrell (D-NJ). "Have you no heart?"

Despite the congressman's plaintive objections during Wednesday's House debate, his Republican colleagues passed a bill 267-159 to repeal the ill-fated CLASS Act. The Community Living Assistance Services and Supports program, championed by the late Ted Kennedy, aimed to provide a long-term care insurance program. Wednesday's party-line vote deepens a partisan stalemate over how to fill that major hole in the U.S. health care system, as the legislation now goes to the Senate where it's expected to perish.

The impasse in a nutshell: The Obama administration conceded last October that it saw no viable path to implement CLASS within its statute, citing financial solvency problems. But the President and his Democratic allies oppose repealing the program and would rather repair it. Republicans, who decry CLASS as costly, unworkable and predicated on a budget gimmick, have no intention of letting that happen. They're insisting on outright repeal and say Congress must start from scratch on the long-term care problem -- although they haven't yet offered an alternative.

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Affordable Care Act

Did Health Care Reform Hurt The Private Insurance Part Of Medicare? Apparently Not

Sahil Kapur | February 1, 2012, 1:15PM

President Barack Obama

The Obama administration announced Wednesday that the Medicare Advantage program, which allows seniors to receive health coverage through a private insurer, is enjoying lower costs and more customers as a result of the health care reform law.

Medicare Advantage enrollment has risen 10 percent over the last year while average premiums have fallen by 7 percent, said Health and Human Services Secretary Kathleen Sebelius. She also pointed out that similar improvements were seen the previous year.

The figures bolster President Obama's defense of his signature achievement, and for Democrats it has the added bonus of refuting earlier Republican warnings that "Obamacare" would gravely undermine the choice provisions in Medicare.

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