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New House Rules Would Amend Requirements on Medicare Board

Proposed House rules for the 113th Congress would make it easier for the chamber to change or repeal recommendations from a controversial board tasked with reining in Medicare spending.

The Independent Payment Advisory Board is a favorite target of Republicans, who oppose it in part because they say it would take power away from lawmakers and give it to unelected officials. The panel was created in the 2010 health care law (PL 111-148, PL 111-152), and its 15 advisers would have to come up with ways to restrict Medicare spending growth if it reaches a certain target.

None of the advisers have been nominated, much less confirmed by the Senate, as the law mandates.

Under the law, the IPAB’s recommendations will take effect automatically unless Congress votes to modify or replace them while still saving the same amount of money and not increasing total Medicare program spending.

The law also set rules for floor consideration in the House and Senate for measures with the board’s recommendations, or legislation to modify or replace those recommendations.

The proposed House rules for the next Congress would eliminate the law’s requirement that any IPAB replacement bill save equal amounts of Medicare money. They also would undo the limitations the law sets on floor consideration of the measures related to IPAB recommendations — such as one limiting consideration of a conference report between the House and the Senate to 10 hours.

“I am pleased to see this provision in the proposed House rules for the 113th Congress,” said Rep. Phil Roe, R-Tenn., sponsor of a bill to repeal the board. “Despite having many procedural obstacles in the way of trying to repeal IPAB, this is the first step of ensuring that this unaccountable board does not do irrevocable damage to Medicare.”

The House Republican Conference will meet Jan. 2 to consider the proposed resolution providing for the rules of the 113th Congress.

The health care law states that the rules for consideration of IPAB recommendations are enacted “with full recognition of the constitutional right of either House to change the rules (so far as they relate to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.”

The House passed a bill (HR 5) in March that would repeal the board, with the support from some Democrats. But Democrats in the Senate have refused to take up the measure.

The law requires the IPAB to submit annual cost-cutting proposals beginning in January 2014 if Medicare’s spending growth is projected to exceed a set rate. But the Congressional Budget Office has estimated that Medicare’s spending will remain below that rate through 2022.

The law says the board cannot recommend restricting benefits, raising premiums, changing eligibility rules, or to “ration health care.”

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