By Representative Pitts
"Gridlock in Washington." It's an all too-common headline in a time when one party controls the House and another controls the Senate and Presidency. It is not an easy process to sort out our differences and reach an agreement on important policies.
How do we deal with this gridlock? A fundamental question facing Washington is whether we let elections and debate in Congress lead to solutions, or whether we give up power to boards of experts. Democracy is certainly messy, but is technocracy really the answer?
Nearly two years ago, the President signed his massive health care bill into law. Among the thousands of pages of text, a section established a new and powerful board to govern Medicare spending--the Independent Payment Advisory Board.
Medicare has a big problem: spending keeps growing faster than revenues. For many years, there were enough workers to support retirees. Now with the Baby Boom generation starting to retire, there simply won't be enough revenue to keep up with how fast the program is growing. Ten thousands workers a day will be retiring for the next 19 years.
IPAB is the President's preferred way of holding back this spending growth. The fifteen-member board is empowered to create plans to cut the growth in Medicare spending. This is perhaps the most powerful bureaucratic board ever established in the United States.
IPAB members will be nominated by the President to serve six-year terms. That is as long a term as a U.S. senator, two years longer than a U.S. president, and triple the time of a U.S. representative.
Members are required to be confirmed by the Senate. However, since President Obama has radically expanded his power to make recess appointments, many of IPAB's members may never actually testify or come up for a vote.
Here's where the definitions become important. IPAB is required to hold back the growth in Medicare spending. The law explicitly says that the recommendations made by IPAB must not result in rationing. However, rationing is never actually defined in the law.
Who gets to determine whether the cuts made by IPAB will lead to rationing? The fifteen members of IPAB, and pretty much no one else.
IPAB's recommendations will not go through standard government rule-making processes and their work will not be transparent. They are not required to hold meetings open to the public. They are also not required to follow the standard rulemaking process that allows for public comments. Their decisions will be final and will not be subject to judicial review. Patients and doctors will not be able to appeal their decisions in court.
The process for Congressional review is convoluted. IPAB will meet and make decisions for three years before Congress can formally object to their decisions. Starting in 2017, Congress can overturn their decisions, but only in a very limited window of time and only with a three-fifths majority in the House and Senate and with replacement legislation that has the same amount of cuts.
No government board has ever operated with so much independence and lack of transparency. When it comes to Medicare, IPAB bureaucrats will be more powerful than elected members of Congress.
I believe IPAB is both unwise and unconstitutional. Government must be accountable to the people, especially when the decisions concern health care. It's not just Republicans who feel the same way.
Rep. Frank Pallone (D-NJ) is my Democratic counterpart on the Energy and Commerce Health Subcommittee. He supports the President's health care law, but is concerned about IPAB. During the Health Subcommittee consideration of legislation to repeal IPAB he clearly stated: "It's not the job of an independent commission to make decisions on health care policy for Medicare beneficiaries."
H.R. 452, the bill to repeal IPAB, has twenty Democratic co-sponsors. It passed out of both the Energy and Commerce Committee and the Ways and Means Committee with bipartisan support.
Before the end of this month, this bill should come to the House floor. If members really believe that power should reside in elected legislatures, and not with bureaucrats, then they should support the bill and demand that the Senate and President give power back to the people.