Those are the two presently options on the table. Republicans are united behind their approach, although they have presented gentler versions of the unpopular Ryan plan to ease the fallout. Democrats, however, are split on their plan. The House GOP's IPAB repeal bill, set to clear the Energy & Commerce health committee today, has 17 Democratic signatories as of this writing, including some key players.
The Democratic cosponsors are Reps. Allyson Schwartz (D-PA), Barney Frank (MA), Joe Baca (CA), John Barrow (GA), Shelley Berkley (NV), Timothy Bishop (NY), Michael Capuano (MA), Kathy Castor (FL), Joe Courtney (CT), Chaka Fattah (PA), Eddie Johnson (TX), Larry Kissell (NC), Jim Matheson (UT), Bill Pascrell (NJ), Loretta Sanchez (CA), Linda Sanchez (CA) and Del. Donna Christensen (VI).
Pascrell, a member of the influential Ways & Means Committee, signed on Monday. Rep. Frank Pallone (NJ), the top Dem on the E&C health subcommittee, has not cosponsored the bill but says he'll vote for it, according to CQ HealthBeat. Schwartz, who runs recruitment at the DCCC, is an outspoken IPAB opponent.
"We all agree that Medicare costs must be contained and that the payment system is flawed and needs to be replaced. But simply cutting reimbursements is not the answer," Schwartz wrote in a USA Today op-ed. "IPAB brings unpredictability and uncertainty to providers and has the potential for stifling innovation and collaboration."
House Minority Whip Steny Hoyer (D-MD) acknowledged Dem divisions on IPAB Tuesday, but defended the panel. "The interesting thing is that the people who are trying to raise the specter of the IPAB are the very ones who are promoting programs to take away benefits from Medicare recipients," he said at his weekly press conference. "So I think it is a somewhat schizophrenic approach on this issue by my Republicans friends." He said leadership has not whipped members against repeal.
The intra-party split is not a huge surprise. The idea of IPAB originated in the Senate and was never well-liked by House Dems. Part of the reason is that IPAB forces them to surrender jurisdiction on Medicare cuts and cost-savings. (The theory is it'll do the work members of Congress are too politically afraid to do.) The other reason is that the health care industry, fearful of IPAB cutting its reimbursements, is working hard to kill it in its cradle.
Sen. John Cornyn (R-TX) this week reintroduced partner legislation, which currently has 19 cosponsors, all Republicans. That's the trouble for Republicans at the moment: Senate Dems aren't joining them. And they're not quite as susceptible to health industry attacks as House members, who have to run for reelection every other year as opposed to every six years.
The defections matter because Dems still have to build support for implementing IPAB. Senate Republicans have hinted they'll block confirmation of any appointees, and will likely be able to. So unless Democrats build enough support for IPAB to force the GOP not to filibuster, or find an alternate way to keep Medicare solvent over the long term, their fissures over IPAB are bad news for the goal of avoiding a Ryan-style shift to subsidized private insurance.
Conscious of the clarity of the choice at hand, Ryan, the House Budget chairman, on Tuesday launched an attack on IPAB at a hearing and touted his vision. "[T]he fate of seniors' care is left in the hands of 15 unelected, unaccountable bureaucrats in Washington," he said, in remarks captured by The Hill. "These bureaucrats are empowered to cut Medicare in ways that will result in restricted access and denied care for current seniors."