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Barack Obama signing Affordable Care Act
President Obama signing the Affordable Care Act
Last month, Gov. Howard Dean penned an op-ed for the Wall Street Journal in which he called a key cost-controlling measure of the Affordable Care Act, Independent Payment Advisory Board (IPAB) "essentially a health-care rationing body," adding his voice to the chorus of attacks, usually coming from Republicans, on the board. He didn't call it a death panel, like Republicans do, and did praise the overall law, but he also opened up room for vulnerable Democrats to hop on the partial repeal bandwagon.
A wave of vulnerable Democrats over the past three months has signed on to bills repealing the board’s powers, including Sen. Mark Pryor (Ark.) and Reps. Ron Barber (Ariz.), Ann Kirkpatrick (Ariz.), Kyrsten Sinema (Ariz.) and Elizabeth Esty (Conn.).

All five are considered vulnerable in next year’s election, highlighting the stakes and the political angst surrounding the healthcare measure. [...]

Two of the lawmakers explained their opposition by suggesting the board would limit care for Medicare patients.

Let's just go back, again, to what IPAB can and cannot do, by law.
There are some things the IPAB can do, some things it may do, and some things it is prohibited from doing. It can propose changes in how some providers are paid or how care is organized. Congress may substitute other ways of reaching the spending targets, but if it does not, the IPAB recommendations take effect. The IPAB may suggest ways to change the health care system outside Medicare. But these recommendations have no binding legal force. The IPAB is prohibited from making any recommendations that would result in health care rationing or that would change Medicare benefits, premiums, deductibles, or cost-sharing.
It can't, by law, ration care. Period. At this point, any power it does have is actually theoretical. It would only kick in if projected Medicare spending exceeded a target level, at which point it makes recommendations on how to reduce Medicare spending. Those recommendations only actually happen if Congress doesn't come up with another solution, and—all together now—it cannot make recommendations that "would result in health care rationing or that would change Medicare benefits, premiums, deductibles, or cost-sharing."

Also, too, it's all theoretical because the 15-member board doesn't exist right now and won't in the near future because the positions have to be nominated by the president, and confirmed by the Senate. Like Republicans are gonna let that happen. Also, too, the CBO says increases in Medicare spending have slowed to the point that the spending target where the IPAB kicks in isn't likely to be reached until 2022.

There is no reality-based reason for Democrats to jump on the repeal IPAB train. None. Unless your reality includes the fact that the American Medical Association, the American Hospital Association and the pharmaceutical lobby have supported IPAB repeal, are all lobbying you to do so, and tying their potential support of your next campaign to it.

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Originally posted to Joan McCarter on Thu Aug 08, 2013 at 01:16 PM PDT.

Also republished by Daily Kos.

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