As Republicans prepare to turn up the heat next week on health care reform’s controversial independent Medicare advisory board, some provider groups are worried that the GOP’s harsh rhetoric could ruin the chances that Democrats will help the repeal effort.
Republicans have set up the Independent Payment Advisory Board as the next health care reform target they hope to pick off, and there’s reason to believe the effort could garner significant support from Democrats.
The board, designed to control the rise of Medicare spending, was included in the law against opposition from dozens of House Democrats, and a handful of Democrats have signed onto a repeal bill in the House. Many provider groups that backed the reform law are now calling for IPAB’s elimination, expecting that the panel’s recommended spending reductions will translate into payment cuts to Medicare providers.
While IPAB is lined up as the next major effort of the GOP’s agenda to repeal health reform, some provider groups are fearful Republican rhetoric could sink repeal’s chances. Their concern is that Republicans have increasingly labeled IPAB a rationing board — a term that has overtones of the “death panel” rhetoric the GOP used against health reform and could alienate Democrats who otherwise would support repealing the board.
Some provider groups, concerned that the issue could become too politicized for Democrats to touch, in the past few months have reached out to Republican lawmakers to ask them to tone down the scary IPAB rhetoric, POLITICO has learned.
“One of the concerns of the medical community is if this becomes too much of a partisan issue, it is less likely to get any movement in the Senate or the president’s signature,” said one health care lobbyist working toward IPAB repeal. “Without Republicans getting Democrats aboard in the House, it becomes a partisan piece and is dead on arrival in the Senate.”
The risk of the partisan messaging is sure to increase next week, when two House panels will hold hearings on IPAB that Republicans could use to spotlight their “rationing board” charges. One of them will be led by House Budget Committee Chairman Paul Ryan, who has been especially vocal about the alleged dangers of the board.
Health and Human Services Secretary Kathleen Sebelius will testify before the Budget Committee on Tuesday and again at an Energy and Commerce Health Subcommittee hearing on Wednesday. The Energy and Commerce panel – whose hearing room has played host to partisan squabbles over health care reform the past few months — is planning a mega-hearing on Wednesday that will feature four separate witness panels.
The lengthy saga that led to the repeal of the health law’s 1099 provision underscores the importance of bipartisanship when it comes to making changes to health care reform. Congressional Republicans and Democrats, as well as the White House, agreed for months on eliminating the law’s tax-reporting requirement, but a partisan disagreement on offsetting the cost of repeal delayed repeal for months.
The health lobbyist, granted anonymity in order to describe his conversations with staffers for Republican House members, said the lawmakers grasp providers’ concerns about IPAB. However, as Democrats attack the GOP Medicare plan and make their own claims of rationing, Republicans have stepped up their attacks on IPAB.
“They believe this is politically beneficial and a good argument in response” to Democratic attacks on the GOP Medicare plan, the lobbyist said.
Rep. Phil Gingrey (R-Ga.), who has said IPAB is “worse than throwing grandma under the bus,” acknowledged that lawmakers are “subject to embellishment.” But he thinks Republicans have presented a strong policy case for repealing the Medicare board.
“I told my colleagues we need to be careful about [rhetoric],” Gingrey said. “We’ve got a strong enough argument that we don’t need to be embellishing it. We don’t need to be over the top.”
IPAB will be a board of 15 health experts, appointed by the president and confirmed by the Senate, who will have to find Medicare savings if the program grows too quickly. Though the board, scheduled to start up in 2013, is forbidden by law from rationing care, Republicans said it will wind up doing just that by enforcing Medicare cost targets.
What makes IPAB an appealing target for elimination is the fact that 72 House Democrats raised serious concerns about the board in December 2009 after it was included in the Senate’s health care reform bill, which was largely approved by the House through reconciliation without major changes.
One of the seven House Democrats who have so far signed on to IPAB repeal legislation includes Pennsylvania Rep. Allyson Schwartz, who’s part of the Democratic leadership. California Rep. Pete Stark, one of the chamber’s leading voices on health care issues, has called the IPAB “a dangerous provision” but isn’t a co-sponsor on the repeal bill.
The House Democrats opposing IPAB said Congress shouldn’t cede its authority over Medicare, and they’re worried that IPAB will hurt the quality of health care. But they’re not using the dreaded “R” word – rationing.
“The threat of reduced payments is the least imaginative option and most unlikely to result in the kind of heath care we know seniors and all Americans deserve,” Schwartz wrote in a USA Today op-ed explaining her opposition to the IPAB.
Health care lobbyists expect more Democrats to back IPAB repeal this month, and they said the two House hearings on IPAB next week may be a good indicator of whether more will jump on board.
“It’s a matter of context,” said one health lobbyist working on IPAB repeal. “If Republicans play straight on this, you’ll get more Democrats to support IPAB.”
Sen. John Cornyn (R-Texas), who’s co-sponsoring the Senate bill to repeal IPAB, said he doesn’t think the rhetoric has damaged the chances of repeal.
“My hope is that with the hearings next week and some follow-along action in the Senate, we can develop a consensus,” Cornyn said. “It’s not a partisan issue. It shouldn’t be a partisan issue.”
However, even if IPAB repeal clears the House with more Democratic support, it would face some serious hurdles. No Senate Democrat has come out publicly against it, and President Barack Obama recommended strengthening the board in his April budget speech.
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