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Republicans see election-year issue in repeal of Medicare cost-control board
WASHINGTON (AP) ' Reaching for a new health care issue they hope will draw an election-year contrast between the parties, Republicans in charge of the House moved Thursday to repeal a Medicare cost-control board that has yet to be appointed, let alone propose any cuts.
The Independent Payment Advisory Board was created by President Barack Obama's health care overhaul law to keep Medicare costs from zooming out of control. Republicans have branded the panel a rationing board. By targeting IPAB (pronounced "EYE-pab"), Republicans hope they can persuade seniors that they, and not the Democrats, are the best stewards of Medicare.
"Obamacare's IPAB is not the solution our seniors are expecting from us," said Rep. Eric Cantor, R-Va., the No. 2 GOP leader. "Our seniors deserve better."
Even some Democrats oppose the panel, but House Republicans have made it difficult to attract Democratic votes for repeal by adding other politically charged provisions to their bill.
"Republicans don't want to see IPAB repealed now because they want to run against it," said Scott Gottlieb, a former senior FDA official in the George W. Bush administration. "I think there will be an effort to repeal it after the election."
Political gamesmanship aside, the debate highlights major differences between the parties on Medicare, the giant health care program for nearly 50 million seniors and disabled people.
All sides agree that Medicare as currently structured will not be able to pay its bills in the long run. The main options to control costs are unpalatable: tax increases, benefit cuts and cost shifts to middle- and upper-income retirees. Most Republicans and Democrats also agree now that there has to be a limit on future increases in Medicare spending to keep the program affordable. The question is how to do that.
Republicans would convert Medicare into a system dominated by private health insurance plans closely regulated by the government. Future retirees would get a fixed payment to buy either private coverage or sign up for a new government plan modeled on traditional Medicare. They count on competition among the plans to help keep costs in check, but the annual government payment would also be limited by tying it to a measure of economic growth.
That's the basic approach embodied in the new budget released this week by Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee. GOP presidential candidate Mitt Romney also would go in the same general direction.
Theoretically, such a system could help rein in Medicare cost increases, economists say. The question is whether it would be politically acceptable to seniors and generations of future retirees. Polls indicate the public is resistant to major changes in Medicare. Recognizing the sensitivity, Ryan's plan would exempt anyone now 55 or older.
Obama and the Democrats would take a far different approach to cost control, and that's where the IPAB board comes in.
IPAB has the power to force payment cuts to service providers if costs rise beyond certain levels and Congress fails to substitute its own plan for savings. But the law explicitly forbids the board from rationing care, shifting costs to seniors, or cutting their benefits. The Democrats would put the burden on drug companies, hospitals, nursing homes and other service providers.
Obama has yet to name anyone to the panel, whose 15 members must be confirmed by the Senate. Government economists are forecasting a period of manageable Medicare costs, meaning that IPAB's services may not be needed until sometime around the end of the decade.
Democrats say they'd rather defend IPAB any day in front of older voters ' and attack the GOP's Medicare overhaul.
"Their approach just hands seniors a voucher," said Rep. Chris Van Hollen, D-Md., the ranking budget committee Democrat. "My view is that the independent board provides an important backstop to Congress for reducing the cost of Medicare without transferring risk to seniors."
The nonpartisan Congressional Budget Office said this week that both Obama's health care law and the new Ryan plan could potentially create access-to-care problems for Medicare recipients. The CBO cautioned that those could turn out to be greater under the GOP approach, which would squeeze Medicare growth harder. Republicans say that won't happen because competition among health plans will keep costs down by reducing waste.
The House bill is likely to hit a dead end in the Senate. The White House issued a veto threat against it earlier this week. House Republicans all but guaranteed that when they paired by IPAB repeal with caps on medical malpractice awards, which most Democrats oppose.