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Republicans are revamping their strategy against President Barack Obama's health care law: If they can't repeal the whole thing, they'll try to pick off pieces. Even better if it's a new and unfamiliar bureaucracy.
The House began debate Wednesday on legislation to abolish the Independent Payment Advisory Board, a yet-to-be-appointed body created by the law to keep Medicare costs from ballooning. Repeal is expected to easily pass the House on Thursday but then die in the Senate, where the Democratic majority solidly supports the board.
Republicans see the House vote as setting up a political issue to turn against Democrats in the battle for seniors' votes in the November elections. Unless the Supreme Court strikes down the law, the GOP is likely to keep going after the Medicare board and other individual provisions of the health care overhaul even if Obama is re-elected.
Known as "IPAB," for its abbreviation, the board has been branded a care-rationing panel by the Republicans. The White House defends IPAB as a check against runaway spending, and has issued a veto threat against the Republican bill.
The House vote is being timed to coincide with the second anniversary of the law this week, giving opponents a fresh rallying cry against what they deride as "Obamacare" ahead of Supreme Court arguments on the overhaul that start March 26.
The health care law authorizes IPAB to control excessive Medicare cost increases by forcing cuts on service providers, unless Congress overrides the board's recommendations. The board is explicitly forbidden from rationing care, shifting costs to retirees, restricting benefits, or raising the Medicare eligibility age.
The cost-cutting panel wouldn't swing into action unless increases in Medicare spending exceeded certain levels keyed to the economy. It's supposed to limit the growth of the Medicare budget, not choke it off.
Nonpartisan government experts are forecasting a period of manageable Medicare costs, making it unlikely the board would have to propose cuts for six or seven years. Obama is in no rush to name any of its 15 members, who would probably face grueling Senate confirmation hearings.
But foes of IPAB aren't likely to wait. The health care industry is nearly unanimously opposed to the board, and consumer groups such as AARP never liked it to begin with.
"A lot of people's worst fears are confirmed in the IPAB," said House Ways and Means Chairman Dave Camp, R-Mich. Repeal legislation "is highlighting a part of the bill many Americans don't support, a power grab by unelected and unaccountable bureaucrats in Washington."
Maryland Rep. Chris Van Hollen, the point man for Democrats on the budget, says using IPAB to control costs would be better than Republican proposals for converting Medicare into a system dominated by private insurance plans.
"Their approach just hands seniors a voucher," Van Hollen said. "My view is that the independent board provides an important backstop to Congress for reducing the cost of Medicare without transferring risk to seniors."
For a while, it looked like Republicans might be able to seize an early advantage in the repeal drive.
Prominent liberals including Rep. Barney Frank, D-Mass., had signed on to the idea, raising the possibility of a strong bipartisan vote in the House that would embarrass Obama and increase chances the Senate would have to deal with the issue.
But then House Republicans decided to combine repeal of the board in the same bill with a cap on jury awards in medical malpractice cases. The latter is a long-sought GOP goal, but a nonstarter for Democrats, who tend to side with those who argue such limits undermine the rights of injured patients. Frank's spokesman says the congressman no longer supports the bill.
Democratic foes of IPAB object to the board for reasons that are different from those of Republicans. The liberal Democrats see it as an unprecedented and unnecessary delegation of power by Congress. They worry that it could harm key industries such as drug companies. But they stop short of the rationing accusation.
Critics of the board also say that because IPAB is basically an attempt to limit the growth of Medicare spending, a stingy approach by the board could stifle promising medical innovations, restricting access even without explicit rationing.
"It will be a random tax on medical innovation," said economist Douglas Holtz-Eakin, an adviser to Republicans.
But with any IPAB-ordered cuts years away, it remains to be seen if Republicans can use the issue to move election-year public opinion.
"Protecting Medicare and sustaining it for the future is an incredibly powerful goal for seniors," said Mollyann Brodie, polling director for the nonpartisan Kaiser Family Foundation. But with IPAB "we are talking about something that is not real for people, and they don't understand how it works."