Medicare rationing? An election-year House vote

RICARDO ALONSO-ZALDIVAR

Asso­ci­ated Press

WASHINGTON — House Repub­li­cans res­ur­rected the specter of Medicare rationing Thurs­day in an election-year vote to repeal cost con­trols in Pres­i­dent Barack Obama’s health care overhaul.

In the GOP crosshairs is a board that has yet to be named but would be empow­ered to force cuts to drug com­pa­nies, insur­ers and other ser­vice providers if Medicare spend­ing bal­loons. A Repub­li­can plan announced this week, lay­ing down a divid­ing line between the par­ties, also would limit Medicare cost increases, but it would rely on com­pe­ti­tion among pri­vate insur­ance plans.

GOP law­mak­ers are hop­ing their sym­bolic 223–181 vote on Thurs­day to repeal the Inde­pen­dent Pay­ment Advi­sory Board will help per­suade seniors that Repub­li­cans, not Democ­rats, are the best stew­ards of Medicare.

The bill is likely to hit a dead end in the Sen­ate. House Repub­li­cans all but guar­an­teed that when they paired the board repeal with caps on med­ical mal­prac­tice awards, which most Democ­rats oppose. The White House has issued a veto threat.

If it all sounds like a debate among Wash­ing­ton insid­ers, Rep. Jack Kingston, R-Ga., says he will have no trou­ble explain­ing to con­stituents why he voted to repeal the cost-cutting board.

“Do you remem­ber death pan­els?” said Kingston, refer­ring to the debunked accu­sa­tion by for­mer GOP vice pres­i­den­tial can­di­date Sarah Palin that Obama’s health care law would allow the gov­ern­ment to with­hold life-saving care from the elderly.

“It’s not nec­es­sar­ily a death panel, but it is a rationing panel and rationing does lead to scarcity for some,” he added. “Who’s going to get the needed treat­ment, an 85-year-old or the 40-year-old with children?”

The health care law explic­itly bars the board from rationing care, shift­ing costs to Medicare recip­i­ents or cut­ting their ben­e­fits. But crit­ics say squeez­ing ser­vice providers will sti­fle med­ical inno­va­tion, achiev­ing a sim­i­lar result.

Many House Democ­rats also oppose the board — dubbed IPAB for its ini­tials — but for dif­fer­ent rea­sons. They feel it dimin­ishes the role of Con­gress. But Repub­li­cans 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“Repub­li­cans don’t want to see IPAB repealed now because they want to run against it,” said Scott Got­tlieb, a for­mer senior FDA offi­cial in the George W. Bush admin­is­tra­tion.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.”

The House vote came a day before the sec­ond anniver­sary of the health care law, and just ahead of next week’s Supreme Court delib­er­a­tions on its con­sti­tu­tion­al­ity. Pol­i­tics aside, the vote high­lighted 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 Medicare increases. The ques­tion is how.

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. The plan counts on com­pe­ti­tion among the plans to help keep costs in check, but the annual gov­ern­ment pay­ment would also be lim­ited by tying it to 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, and sec­onded by GOP pres­i­den­tial can­di­date Mitt Romney.

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 future gen­er­a­tions, with polls indi­cat­ing that the pub­lic is resis­tant to major changes. Rec­og­niz­ing the sen­si­tiv­ity, Ryan’s plan would exempt any­one now 55 or older.

Obama and the Democ­rats would take a dif­fer­ent approach to cost con­trol, and that’s where the IPAB board comes in.

IPAB (pro­nounced EYE-pab) 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 ser­vice providers, such as drug com­pa­nies, insur­ers and even­tu­ally, hospitals.

Obama has yet to name any­one to the panel, whose 15 mem­bers would have to 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 before older vot­ers — and attack the GOP’s Medicare overhaul.

“The rationing is in the Repub­li­can plan,” said Rep. Chris Van Hollen, D-Md., the rank­ing Demo­c­rat on the bud­get com­mit­tee. “What they do is allow insur­ance com­pa­nies to ration people’s health care.”

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.

Posted by AP News on Mar 22 2012. You can follow any responses to this entry through the RSS Feed. Comments can be made below.