On Sunday, the New York Times ran an editorial asking how Republicans can continue to bemoan the growing national deficit and rising health care costs, while simultaneously introducing legislation to eliminate the cost-saving measures of the health care law. The GOP has introduced several bills to repeal the entirety of reform and at least two measures to rescind the new Independent Payment Advisory Board, “which is supposed to come up with ways to rein in excessive Medicare spending — and stiffen Congress’s spine“:
Starting in 2014, whenever Medicare’s projected spending exceeds a target growth rate, the board of 15 members (drawn from a range of backgrounds, appointed by the president and confirmed by the Senate) will have to recommend reductions in payments to doctors and health care providers to bring spending back to target levels. These recommendations would become law unless Congress — not known for its political courage in such circumstances — passed an alternative proposal that would achieve comparable savings.
None of this poses any real threat to Medicare beneficiaries. The law prohibits the board from making proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase premiums or cost-sharing, or reduce low-income subsidies for drug coverage. It cannot call for a reduction in payments to hospitals before 2020.
If anything, we fear that the board’s power will be too limited. But its power to curb payments to other providers is projected to save $15.5 billion to $24 billion between 2015 and 2019.
That has not stopped Senator John Cornyn of Texas from trying to kill off the board. In July, he introduced the ever so cutely named “Health Care Bureaucrats Elimination Act.” It currently has 11 co-sponsors, and a similar version, introduced earlier in the House by the Republican Phil Roe of Tennessee, has 54 co-sponsors.
The bill will provide Republicans with the opportunity to reiterate their top line health care messages in the midterm elections and I expect to hear many of the familiar arguments about rationing health care and pulling the plug on grandma that animated last year’s reform debate. But this kind of tactic only works because the bill will never actually make it to the floor for a debate, much less became law.
In reality, it’s not in the GOP’s political interest to actually vote for such a thing. As the CBPP’s Robert Greenstein points out, “the fiscal pressures on the whole federal budget moving going are going to be so severe and Medicare plays such a central role in this” that policymakers from either party will need to find efficiency savings in Medicare. IPAB’s savings will be particularly valuable because they’ll target “payment and delivery system reforms, rather than from the more unpopular approach of cutting beneficiaries’ benefits and raising premiums.”