The House voted Thursday to repeal a central provision of the 2010 health care overhaul, the Independent Payment Advisory Board (IPAB).
The vote was 223 to 181, with seven Democrats voting with most Republicans to abolish IPAB. Ten Republicans voted against the effort to kill IPAB.
The board’s job is to propose cost-saving changes to Medicare if per capita spending on that program exceeds a target, the national income growth rate, plus 1 percent. The IPAB changes would automatically take effect unless Congress blocked them or enacted its own cost-saving measures.
The House vote took place only four days before the Supreme Court begins hearing oral arguments on the constitutionality of other provision of the 2010 law.
Thursday’s vote will have little more than a symbolic election-year effect since if the Senate were to vote on IPAB, Democrats have enough votes to keep it alive.
And the board, which is supposed to have 15 members with expertise in medical care and economics, still exists only on paper: President Obama has not yet nominated anyone to serve on it. Its members are subject to Senate confirmation.
But the White House has issued a veto threat against the House bill, saying it would dismantle IPAB “even before it has a chance to work. The bill would eliminate an important safeguard that… will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries….”
The 2010 Affordable Care Act which created the board, says IPAB can’t ration care, restrict benefits, increase the premiums Medicare recipients must pay, or alter the eligibility for Medicare. But it can limit or change payments to doctors, hospitals, hospices, and other providers.
After the vote, the chief proponent of IPAB, Sen. Jay Rockefeller, D- W.V., issued a statement denouncing the move to abolish it.
“Today’s House vote is a good example of what happens when special interests win – seniors lose,” he said. “The Independent Payment Advisory Board was created to protect Medicare for seniors – by improving the quality of Medicare services and by extending the life of Medicare for years to come."
In House debate Wednesday, Rep. Sander Levin, D- Mich., defended IPAB, saying, “For conservatives who talk about the importance of cost containment, they want to repeal an act that has within it not only the seeds of cost containment, but the instrumentalities of it. In fact, they’re beginning to work well enough. That’s why CBO (Congressional Budget Office) says that it’s going to be 10 years before IPAB is triggered.”
But Rep. Dan Lungren, R- Calif., said, “The idea that 15 unelected individuals on the Independent Payment Advisory Board have been empowered by the so-called Patient Protection and Affordable Care Act to ration health care for seniors—and that’s for all seniors— is as Orwellian as these titles crafted by the previous Congress to divert attention from what’s really being done here.”
He said that IPAB “raises the most serious ethical concerns about respect for the dignity of our seniors. This is the unfortunate consequence of a world view which favors the notion of bureaucratic expertise and efficiency as a solution to the challenges facing our health care system today.”
The House bill also included a provision to impose a $250,000 cap on noneconomic damages and to limit the contingency fees lawyers can charge in medical malpractice cases.