(Department of Health and Human Services website)

WASHINGTON — The panel tasked to cut Medicare costs in the 2010 health care reform law is under attack by Republicans and also some Democrats who complain that the 15 appointed members on the board have little accountability to Medicare recipients.

A bill, which has the sole purpose of eliminating the Independent Payment Advisory Board created as part of the health care law, was approved by the House Energy and Commerce Committee on Tuesday. Companion legislation introduced by Sen. John Cornyn, R-Tex., is unlikely to pass in the upper chamber this year. It has no Democratic co-sponsors.

The bill moving through the House, on the other hand, has the support of many Democrats — 19 of them are even co-sponsors. Its next step is consideration and a possible vote in the Ways and Means Committee, planned for Thursday.

On Tuesday, Ways and Means health subcommittee chairman Wally Herger, in a statement, quoted Democratic Rep. Pete Stark, in the course of   a hearing on the embattled advisory board. Herger, R-Calif., called the panel “a mindless rate-cutting machine that sets [Medicare] up for unsustainable cuts that will endanger the health of America’s senior and people with disabilities.”

But Rep. Henry Waxman, the top Democrat on the Energy and Commerce Committee, called the attempted repeal a “Republican assault on Medicare.”  The California Democrat claimed that the legislation would increase Medicare costs by $2 billion, with no word from the GOP on how the overrun would be paid.

Many Republicans favor a voucher-like system that they say would allow the free market to drive Medicare prices down and increase the quality of care.

House Republicans approved a bill repealing the entire health care law last year, but it was just symbolism. Senate Democrats put the measure on ice and President Barack Obama vowed to block the legislation if it ever reached his desk.

It seems that Republicans’ strategy is to dismantle certain pieces of Obamacare.

The independent board was included in Obama’s Affordable Care Act as an attempt to remove politics from the difficult decisions needed to help keep Medicare costs under control.

Under current law, if Medicare spending grows at a rate exceeding economic growth, the chief actuary for the Centers for Medicare and Medicaid Services (CMS) will determine the size of Medicare cuts that need to be achieved. Then, this advisory board will have to create a plan detailing how saving will be found, without the benefit of any new revenues.

If Medicare spending does grow faster than the economy, the first proposal would need to be submitted in to the actuary as early as January 2014. If the actuary does not approve the panel’s decisions, the Health and Human Services Secretary will be required to submit a plan to cut spending by the same CMS-dictated amount.  The cuts would go into effect in 2015.

This process has led to concerns about health care rationing. The board would have a fixed amount of spending reductions that must be achieved. Yet it is charged to not decrease the quality of care, or make up the missing revenue with tax increases.

The bipartisan support for doing away with this advisory payments board stems from the idea that individuals have the right to hold their government accountable. There is no required time allotted for public comment on the board’s cuts, and the only way Congress could overturn its decisions would be to pass a bill with the same amount of cuts. And it would take a supermajority to do that.  Once decisions are made, Medicare beneficiaries and providers also will not have the opportunity to appeal them under judicial review.

Where does the term ‘death panel’ come from?

The Independent Payments Advisory Board has been referred to as a “death panel.” This phrase stems from some critics’ fear that the board would have to start rationing health care to achieve the formulaic Medicare cuts determined by the chief actuary of CMS.

The term originated from a Facebook post from former vice-presidential candidate, Sarah Palin, who said seniors and the disabled “will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”

PolitiFact dubbed this quote its lie of the year in 2009, because there is no panel set up to judge an individual’s “level of productivity in society” or to determine if one is “worthy” of care.

Nevertheless, Palin has said she would continue to use the term, “death panel.”


This payments panel would consist of unelected members nominated by the president in the same manner as Supreme Court justices and other executive branch officials.  Appointees would have to be confirmed by the U.S. Senate. Obama, who has been a fervent supporter of this advisory panel, has not yet appointed any of its members.

This bill was approved by Health subcommittee on Feb. 29 in a 17-5 vote, with support from Democratic Reps. Frank Pallone Jr. of New Jersey, and. Edolphus Towns of New York. Four Democrats were absent and did not vote. One was Rep. Jim Matheson, D-Utah a co-sponsor.

Pallone, the top Democrat on the health subcommittee, has consistently opposed the unelected board because he sees it as executive overreach and an infringement on congressional authority. “I’m opposed to an independent commission playing a legislative role other than on a recommendatory basis,” he said. “It’s not the job of an independent commission to make decisions on health care policy for Medicare beneficiaries.”

Towns agreed, saying that he worries that the board “could not know what the 72,000 Medicare-eligible seniors in my district will need.” While Towns still supports the health care law as a whole, he admits there are parts that need refining.

Lawmakers need to take into account what the experts say, Matheson said, but the question is how much their advice can be implemented without Congress’ consent. “There’s that balance you are always looking for,” he said. Matheson’s main concern about the panel is not its power, but how it is structured. Congress needs to consult physicians to ensure patients’ care and cost cutting are both considered in decision-making, he said.

Last week, the James Madara, CEO of the American Medical Association, supported the repeal of the advisory panel in a letter sent to Rep. Joe Pitts, head of the health subcommittee. Madara wrote that the payment panel’s formulaic cuts that would be based on uncertain projections would be harmful for patients’ care.

Madara said any attempts to help reduce the deficit and control growth should be “by Congress working in a bipartisan manner to reform the delivery system and improve quality, access and efficiency.”