Medicare pay panel latest target of GOP effort to repeal reform law

Republicans continue to try to weaken the law, setting their sights on the Medicare Independent Payment Advisory Board.

By Doug Trapp — Posted Feb. 7, 2011

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Congressional Republicans continued their offensive against the national health system reform law by introducing a bill that would eliminate the Medicare Independent Payment Advisory Board. The board could mandate physician pay cuts starting in about four years.

The two-page measure, sponsored by Rep. Phil Roe, MD, (R, Tenn.) and introduced on Jan. 26, would strip the IPAB provision from the health reform law. If left unchanged, the panel will be instructed to help extend the solvency of Medicare when it begins its work on Jan. 15, 2014.

"The IPAB does not have a mandate to improve patient care, but simply to meet a budget. Naturally, my concern is that this board will harm patient care," Dr. Roe said. Sen. John Cornyn (R, Texas) will co-sponsor a Senate version of the bill, said Amanda Little, a representative for Dr. Roe.

At this article's deadline, Dr. Roe's bill had 23 co-sponsors.

The IPAB is a 15-member board aimed at improving Medicare quality and cutting costs when the program's per capita growth rate exceeds a specified target. Its members will be appointed by President Obama and face Senate confirmation.

The board's recommendations could take effect as early as 2015 unless Congress either passes an alternate proposal with the same level of budgetary savings or overrides the original proposal by two-thirds majorities in both houses. The Congressional Budget Office estimated that the IPAB would save the program $13 billion over a decade.

Although pay cuts are not a required element of the IPAB's work, the American Medical Association has expressed concern that the cost-cutting directive could lead to reductions in physician Medicare rates on top of existing cuts mandated by Medicare law. The AMA supports rescinding the board or significantly revising its directive.

Dr. Roe noted that many Democrats have objected to the IPAB. Bipartisan concerns exist over a perceived lack of congressional oversight of the board.

Looking for weaknesses

The IPAB repeal is the latest GOP salvo in the fight to repeal or roll back parts of the health reform law. GOP members voted for a full repeal of the statute in the House.

At this article's deadline, the Senate was preparing to consider that repeal as a Republican amendment to a Federal Aviation Administration reauthorization bill, but the attempt was expected to fail. So Republicans also are pursuing individual revisions to the law that might have more of a chance of passing in the current Congress.

Of all the GOP proposals so far, the attempt to repeal the health reform law's business expense reporting requirement appears to have the most bipartisan support. A bill by Sen. Mike Johanns (R, Neb.) has 60 co-sponsors, including 15 Democrats.

The reporting provision requires a business to file a 1099 form with the Internal Revenue Service for every vendor with whom it spends at least $600 annually on goods and services, beginning in January 2012.

This requirement -- included to increase tax collections by $17 billion and help offset the health reform law's cost -- could be a bureaucratic headache for many physician practices, according to the American Medical Association, which supports the repeal.

Obama has indicated his support for a repeal of the reporting provision.

Two competing efforts to undo the tax reporting requirement failed late last year, despite some bipartisan support. But Johanns said he is confident his measure will pass eventually. "President Obama called for it, job creators are pleading for it. Now it's time for Congress to act on it," he said.

Senate Democrats have offered their own version of the proposal.

Not every health reform revision introduced by Republicans would stop physician pay from being cut.

A spending reduction measure introduced in the House is designed primarily to cripple the health reform law by cutting off appropriations for key coverage expansion efforts. But it also would cut off appropriations for the Medicare and Medicaid meaningful use bonuses that started going to physician practices this year for the adoption of electronic medical records. Supporters of the financial incentives said the spending reduction bill had little chance of becoming law.

Other GOP legislative efforts target a tax on medical device manufacturers as well as coverage mandates for employers and individuals.

Beyond the legislative arena, a more direct threat to the law exists in the form of a 26-state lawsuit against it. In the latest decision in the case, a federal judge in Florida on Jan. 31 declared unconstitutional the health reform law's requirement for individuals to buy health insurance or pay a tax penalty starting in 2014. The Obama administration plans to appeal the decision. Many legal experts expect the case to reach the U.S. Supreme Court.

Democrats push back

Democrats have been fighting the GOP campaign against the health reform law by promoting its consumer protections and financial assistance and accusing Republicans of distorting the law's impact.

Obama said in a Jan. 28 speech at a health care consumer advocacy conference in Washington, D.C., that Republicans have used scare tactics to generate opposition to the law.

"You may have heard once or twice that this is a job-crushing, granny-threatening, budget-busting monstrosity," he said. "That's about how it's been portrayed by opponents. And that just doesn't match up to the reality."

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A multipronged attack

After a Jan. 19 House vote to repeal the entire national health system reform law, Republicans in Congress began a legislative assault aimed at weakening the bill along several, smaller fronts. They include:

  • Repealing the Medicare Independent Payment Advisory Board provision. If left in effect, the IPAB potentially could mandate Medicare pay cuts starting in a few years.
  • Repealing a tax provision designed to increase collections. If left in effect, businesses would be required to file a 1099 form with the Internal Revenue Service for every vendor with whom they spend at least $600 annually on goods and services.
  • Allowing states to opt out of implementing the health reform law. States that provide a coverage program at least as comprehensive as the national law could avoid its requirements, including the mandate for individuals to have health insurance.
  • Defunding health reform implementation. Spending reduction efforts would halt appropriations for reform initiatives that require them, but they also would end Medicare and Medicaid bonuses for meaningful use of electronic medical records systems.

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