The symbolic House vote on Jan. 19 to repeal the health-care reform law was a tightly scripted set piece. It won't fly in the Senate, but Republicans aren't backing down and will soon begin the real work of trying to dismantle President Barack Obama's signature achievement.
Leading the charge will be a growing number of Republican doctors in Congress. These physicians-turned-lawmakers are looking to eliminate or diminish the power of a cost-cutting board that the Congressional Budget Office says could slash $15 billion from Medicare, the federal health program for the elderly and disabled, through 2019. The law allows the 15-member Independent Payment Advisory Board to make cuts in payments to physicians and drug companies as early as 2014. Hospital payments can't be targeted until after 2019. The GOP doctors view that as a threat to physicians' wallets and professional independence, and are pressing to roll back the law. They now number 15, up from 9 before the midterm elections. The House GOP Doctors Caucus also includes two dentists and is co-chaired by a psychologist, Representative Tim Murphy of Pennsylvania, and an obstetrician, Representative Phil Gingrey of Georgia.
The payment advisory board's authority is immense: To meet a spending target, it can cut whatever it chooses as long as it doesn't ration care, raise premiums, or increase co-payments. Congress can't override its decisions without finding offsetting reductions. White House officials led by Peter Orszag, the former budget director, singled the board out as one of the most important cost-reduction parts of the law. Perhaps more than any other provision, the panel could reduce the income of Medicare providers.
The panel—its members, appointed by the President, haven't been named yet—is "the most destructive" aspect of the law, says Representative Tom Price (R-Ga.), an orthopedic surgeon, because it will serve as a de facto "rationing board" for the federal government. "I know from talking with some of the doctors in Congress, there's deep concern" says Representative Charles Boustany (R-La.), a cardiovascular surgeon.
The Pharmaceutical Research and Manufacturers of America, the drugmakers' lobby, has also made the board's elimination its top priority. Last year, Republicans criticized drugmakers for striking an agreement with the Obama Administration. The companies offered $80 billion in discounts and refunds over 10 years to help pay for the law. The concessions may have insulated the pharmaceutical industry from tough new rules or price controls even as the bargain angered Republicans. Michael Steel, a spokesman for House Speaker John Boehner, recently called the arrangement a "backroom deal" that led to bigger profits for drug companies. House Republicans will put all that behind them, says Gingrey. "In this business, you have no permanent friends and no permanent enemies," he says.
The physician members plan to seek hearings on the cost-cutting board and push for its elimination. Representative Phil Roe (R-Tenn.), an obstetrician, intends to propose a measure soon to repeal the board outright.
Democratic senators are likely to resist undermining the Medicare board. Senators Jay Rockefeller (W.Va.) and Max Baucus (Mont.), the chairman of the Finance Committee, last year argued for the board's inclusion in the final version of the overhaul legislation, despite concerns it would weaken Congress's authority over Medicare and set the program up for steep payment cuts.
For that reason, Richard Tarplin, founder of Tarplin Strategies, a Washington (D.C.) consulting firm on health care and other issues, says repeal of the board is a long shot, although "there will be opportunity" to refine it. Among the possibilities: strengthening Congress's ability to avert any cuts the board recommends, and making allowances for increased Medicare spending in an emergency.
The bottom line: Republican physician-lawmakers want to dismantle a Medicare cost-cutting board that could hit doctors in their wallets.