Our guest blogger is Neera Tanden, Chief Operating Officer at the Center for American Progress, who most recently served as senior advisor for health reform at the Department of Health and Human Services, advising Secretary Kathleen Sebelius and working on the president’s health reform team to pass the bill.

Yesterday as Washington was gripped by the contentious debt limit debate, Doug Schoen, a pollster by trade, took to the Huffington Post to assault the Independent Payment Advisory Board (IPAB) — a 15-member board of medical experts that was created by a provision in the Affordable Care Act. The board, whose members will be appointed by the President and confirmed by the Senate, is tasked with making binding recommendations to reduce expenditures in the Medicare system, unless Congress acts to alter the proposal or discontinue automatic implementation.

Schoen argues that IPAB will have to make steep cuts to meet annual targets. However, today, Republicans are proposing initiatives to dramatically cut Medicare, as the Ryan plan does and House Speaker John Boehner’s debt ceiling measure will likely do. Schoen says that changes to Medicare should be decided by elected officials, who will be held accountable for their decisions. But right now, members of Congress can lobby the Centers for Medicare and Medicaid Services to pay for unnecessary or untested treatments that drive up costs.

The purpose of the IPAB is to ensure policies are not based on the special interests of legislators. Indeed, the IPAB will be comprised of medical experts who can spend the time crafting policies to lower Medicare expenses while improving quality of care and Congress can override the recommendations if they choose. The question really is, do we prefer Congress making decisions on health care delivery instead of doctors, consumer leaders and other medical experts? By taking the politics out of the equation, meaningful payment reform and cost containment can be achieved, as it will not be hindered by payment providers’ undue influence. In fact, lawmakers who oppose the IPAB have received hundreds of thousands of dollars in campaign contributions from health care companies. This political sway was one of the key reasons Senator Jay Rockefeller (D-WV) constructed the IPAB model, stating “It is long past time that Medicare payment policy is determined by experts, using evidence, instead of by the undue influence of special interests.” To further ensure independence, a majority of members must be non-providers and cannot hold any other jobs. Read more

House Minority Leader Nancy Pelosi (D-CA) said Americans can “kiss Medicare goodbye” if House Speaker John Bohener’s (R-OH) debt ceiling compromise is passed into law, during a press conference earlier today. Pelosi was likely referring to a 12-member bipartisan committee in Boehner’s proposal that will be tasked with finding at least $1.5 trillion in savings from programs like Medicare, Medicaid, and Social Security:

PELOSI: This bill, in one fell swoop, just pulls the plug on progress for America’s families. Progress made in the last 50 years. As you know, we served the 46th anniversary yesterday of the signing of the Medicare bill. You can just kiss Medicare goodbye.

Watch it:

Robert Greenstein of the Center on Budget and Policy Priorities (CBPP) has described Boehner’s proposal as “tantamount to a form of ‘class warfare’” that “if enacted, it could well produce the greatest increase in poverty and hardship produced by any law in modern U.S. history.”

The American Action Network — a conservative group backed by Republicans with close ties to Wall Street — “is launching a large-scale mail and newspaper ad campaign” to shore up Republicans by attacking Democrats for allegedly balancing the budget “on the backs of seniors” and introducing “radical” “Medicaid-style rebates to the Medicare Part D program.”

“The mail campaign will reach 22 congressional districts in 14 states, all of them represented in Congress by Republicans,” Politico reports. Below is a sample:

The Medicaid Part D changes are a reference to Rep. Henry Waxman’s (D-CA) proposal (and Sen. Jay Rockefeller’s (D-WV) companion Senate bill) to extend Medicaid drug rebates to dual eligibles — beneficiaries who qualify for both Medicare and Medicaid — and is only as “radical” as, well, health policy in 2003.

Waxman introduced the legislation after the 2003 Medicare part D law moved the 6 million dual eligibles into the Medicare part D program, thus creating a windfall for the industry. Whereas Medicaid obtained an average discount of about 34 percent from pharmaceutical companies that participated in the Medicaid program, “the average discount obtained by the Part D plans was 14 percent,” according to a report issued by Waxman. As he put it, “The drug companies are making the same drugs. They are being used by the same beneficiaries. Yet because the drugs are being bought through Medicare Part D instead of Medicaid, the prices paid by the taxpayers have ballooned by billions of dollars.” CBO estimates that if drug manufacturers provided the Medicare Part D program with the same prices that Medicaid receives, the government could save $112 billion over 10 years.

And if anyone is looking to balance the budget on the back of seniors, it’s not the Democrats — whose current proposal (Sen. Harry Reid’s plan) excludes any cuts from entitlement programs. It’s the Republicans who will benefit from AAN’s flyers.

The GOP voted against the Affordable Care Act — which extends the life of Medicare by 9 years and provides rebates to seniors who fall into Medicare Part D’s doughnut hole — and they supported Paul Ryan’s budget. That plan eliminates the supplemental Medicaid coverage that dual eligibles enjoy and replaces it “with a medical savings account” that, based on CBO estimates, would result in a 65-year-old who lives at the poverty line to pay “$4,700 more in 2022 than he or she would under the programs as they exist today.”

If the 22 Republican members vote in favor of Speaker John Boehner’s (R-OH) debt ceiling proposal later today, seniors will fare even worse. They’ll face cuts of billions of dollars from a commission that would tasked with finding $1.5 trillion in savings by “cutting Social Security and Medicare benefits heavily for current retirees. ”

A new health care tracking poll from the Kaiser Family Foundation finds that as the opposition to the Affordable Care Act has fallen (from 46 percent to 43 percent), a majority of Americans (53 percent) want lawmakers to expand the law or keep it, and 46 percent say they are still confused by it:

On the debt debate, Americans “see a role for reducing spending in deficit reduction,” but majorities continue to say they would not support any reductions to spending on Social Security (62 percent) or Medicare (59 percent), and almost half (48 percent) say the same about Medicaid:

A new report from the Medicare Office of the Actuary estimates that “health spending will grow by an average of 5.8 percent a year through 2020, compared to 5.7 percent without the health overhaul.” As a result, the nation is expected to spend “$4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year”:

In 2014, when the major coverage expansions of the health law begin to take effect, national health spending is expected to grow 8.3 percent, according to the new analysis. But spending growth should return to its 6 percent historical average from 2015 to 2020 as some employers drop coverage and the so called “Cadillac tax” on high-cost insurance plans takes effect in 2018. “The effect is likely to be a slowdown in the growth of health services, health insurance premiums and health spending overall,” the study said.

Look:

Election-centric Orrin Hatch is already out with a statement claiming that reform makes “sky-rocketing healthcare costs worse,” but he would be well served to read the report more closely. CMS is saying that the law expands coverage to 30 million Americans while increasing the average annual growth in national health spending by just 0.1 percentage points over 10 years and predicts that expenditures will fall as cost-controls like the excise tax decelerate health care spending over the long haul. That’s a good deal that establishes a more sustainable and stable health care system, and it will likely only improve as provisions like the Independent Payment Advisory Board (IPAB) kick into higher gear. The report also found that in 2014, “out-of-pocket spending is projected to decline 1.3 percent, largely as a result of the uninsured attaining health coverage through Medicaid or health insurance exchange plans.” Overall, “out-of-pocket share of national health expenditures is projected to fall from 12 percent in 2009 to 9.6 percent in 2020.”

The CMS projections may also underestimate the savings from the delivery reforms and productivity adjustments — which will encourage providers to deliver quality care more efficiently. Those kinds of changes have led to real savings in the Geisinger Health System, Health Partners, Denver Health, and if properly implemented, could result in larger reductions in national health care spending than what the actuary is predicting.