Would Obama Let the Panel Die?
Dr Roe says he still hopes Obama might abandon the IPAB before the bill gets to a veto. "I don't know if the president is really hooked on IPAB," he says. "He hasn't even appointed any members yet."
There are other reasons, however, why the IPAB's 15 members haven't been appointed. Even if they could survive a grueling confirmation gauntlet in the Senate and were seated, they wouldn't have anything to do. Medicare inflation is still too low.
But expectations that Obama might voluntarily do away with the controversial board still linger, encouraged in part by remarks made by Sylvia Mathews Burwell, the new Health and Human Services (HHS) secretary, at her confirmation hearing in the Senate a year ago.
"I actually am hopeful ... that IPAB never needs to be used," she said. She then repeated that message for the senators: "In the current window that we are looking at ... it is our estimate that actually it would never be activated."
Some IPAB opponents pounced on these comments. If the board would never be activated, then why not just get rid of it? They overlooked Burwell's liberal sprinkling of conditionals: that she was "hopeful" the board wouldn't be needed, and that her estimate was based on "the current window."
The administration, in fact, has been saying for years that the IPAB is simply a backup tool that may never be used. In a 2011 speech, Obama said he believed other measures in the ACA would restrain costs on their own, but "if we're wrong, and Medicare costs rise faster than we expect, then this approach will give the independent commission the authority to make additional savings by further improving Medicare," he said.
Looking for Bipartisanship to Override a Veto
Dr Roe, however, isn't counting on Obama to voluntarily give up the IPAB. The Tennessee Republican says he wants to assemble enough votes in the House to override a presidential veto. He reports that the bill now has 214 co-sponsors, just shy of a majority needed to pass it, but it would need 290 votes to override a veto.
An override means winning the support of 43 Democrats—usually an impossible dream in the highly polarized House—but Dr Roe believes it's feasible for this effort. Anti-IPAB sentiments run deep among House Democrats, he says, noting that former Rep. Barney Frank (D-Massachusetts) joined the previous repeal effort. The board, a creature of the Senate, was never part of the House's version of the ACA. As House Democrats see it, "the House abdicated its power of the purse when it allowed the Senate to put IPAB into the healthcare bill," Roe said.
"This is going to be a bipartisan bill," Dr Roe adds. "In fact, it's always been a bipartisan bill." It has always had a Democratic co-sponsor—this time Rep. Linda Sánchez (D-California).
The Republican takeover of the Senate has completely altered the political equation, Dr Roe says. In the past 2 years, he didn't introduce the repeal bill in the House because he believed former Senate Majority Leader Harry Reid wasn't going to bring it up in the Senate. An IPAB repeal bill was introduced in the Senate in January 2013 but it got nowhere. Repeal efforts in the last Congress were "a waste of time," says Dr Roe.
But even with the Senate now run by the GOP, the Tennessee congressman expects that the repeal bill will face more difficulties there than in the House. The Democrats may now be in the minority, but they can still use the filibuster to block legislation, he says.
Dr Roe says he's working hard for bipartisanship. His 2012 bill passed the House by a vote of 223-181, but without much Democratic support. This was because House leaders combined the measure with a tort reform bill—an anathema to many would-be Democratic supporters. The decision infuriated former Rep. Allyson Schwartz (D-Pennsylvania), the chief Democratic sponsor of the 2012 bill. "By unnecessarily tying repeal of IPAB to a partisan malpractice bill, House Republicans have effectively ensured that this bill is dead," she told Talking Points Memo. "This is deeply disappointing."
No one wants a replay of what happened in 2012. Even physician groups that would dearly love to have tort reform are wary of tying it to IPAB repeal again. In 2012, "tort reform was viewed as a poison pill that drove many Democrats away," says Katie Orrico, director of the Washington office of the American Association of Neurological Surgeons and contact person for the Physician IPAB Repeal Coalition, representing 27 specialty organizations.
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Cite this: Leigh Page. Is the IPAB Still Alive and Well? - Medscape - May 28, 2015.