The repeal of the Independent Payment Advisory Board will get a full House hearing on Wednesday after the House Committee on Rules voted late Tuesday afternoon to pass HR 5 (the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011).
By a 7-4 vote, the committee agreed to bring HR 5 and six amendments to the House floor for six hours of general debate. A vote could come as early as Wednesday.
Created as part of the Patient Protection and Affordable Care Act, the 15-member IPAB board is empowered to analyze the drivers of Medicare cost growth and then to recommend to Congress policies to control those costs, if spending exceeds a targeted growth rate. IPAB recommendations are to be put in place unless Congress votes to block them and comes up with equivalent cost-cutting measures.
HR 5 links the IPAB repeal to medical malpractice caps. The two were originally in separate bills, but last week House Republicans decided to combine them into a single bill. Although the IPAB repeal has enjoyed bipartisan support as it has moved through the House committee system, the decision to attach the IPAB repeal to med-mal has placed Democrats, who typically oppose tort reform, in the awkward position of having to choose between two large stakeholder groups—the American Medical Association, which wants IPAB repealed or the American Bar Association, which opposes medical malpractice caps.
Democrats held out some hope that the Rules Committee would agree to separate IPAB and med-mal reform. Instead, the committee kept the bill intact and approved the six amendments for consideration by the full House.
Rep. Allyson Schwartz (D-PA), an early advocate of IPAB repeal, issued a statement to the committee asking Republicans to "set aside political showmanship and bring a clean bill to repeal IPAB to the floor for a vote. Linking this bill to tort reform—an unrelated, divisive, and partisan issue—is bringing what was once a bipartisan effort to a screeching halt. I urge the Rules Committee to reject this offset."
Even a Republican, Rep. Paul Broun, MD, (R-GA) challenged the committee to separate the two bills. "We need to get rid of IPAB. If you marry the two bills you’re going to lose people on both sides and we’ll be less like to get rid of IPAB," he told the committee.
The six proposed amendments include one that would strike the IPAB repeal from the bill and another that would strike medical malpractice caps. Other amendments support efforts to delay implementation of the bill until the Secretary of Health and Human Services submits to Congress a report on the potential side effects of the bill on health care premiums; to extend liability coverage to on-call and emergency room physicians; grant limited civil liability protection to health professionals that volunteer at federally declared disaster sites; and restore the application of antitrust laws to the business of health insurance by amending the McCarran-Ferguson Act.
The White House issued a statement of administrative policy and formally threatened to veto the bill. "HR 5 would repeal and dismantle the IPAB even before it has a chance to work. The bill would eliminate an important safeguard that, under current law, will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries and the traditional program."
The statement added that "the administration opposes placing artificial caps on malpractice awards which will prevent patients and other claimants who have been wrongfully harmed from receiving just compensation. The administration is committed to strengthening Medicare, protecting patients, and supporting the physicians who care for them. We believe that this legislation fails to accomplish these goals. If the President is presented with HR 5, his senior advisors would recommend that he veto the bill."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
