Published April 29, 2013
“It is not anticipated that any… recommendation would be targeted until 2019.”
-- Health and Human Services Secretary Kathleen Sebelius in House testimony last week on the still-vacant 15-member Independent Payment Advisory Board, which is supposed to begin work on Tuesday.
Under President Obama’s 2010 health law, the government officials in charge of keeping Medicaid afloat have until Tuesday to report whether costs for the fiscally foundering program will exceed expectations.
But they won’t have anywhere to send their report.
That’s because the Independent Payment Advisory Board – perhaps the most controversial entity created under Obama’s law – still doesn’t exist.
This 15-member board, denounced by critics as a “death panel,” is tasked under the law with determining which patients ought to receive which treatments and whether taxes ought to be raised to finance the program.
The board has been the centerpiece of the warnings from the right about a dystopian socialist future in which government actuaries decide which senior citizens qualify for new hips or bypass surgeries, and which do not. If you don’t have a long enough life expectancy, you don’t get expensive surgeries to improve your quality of life. If you don’t have a high-enough quality of life, you don’t get expensive life-saving surgeries.
While private insurance already does this sort of thing, seating the power in the government caused a ripple of fear in the months before the passage of the law and thereafter. Denying care may be the simplest way to keep Medicare afloat, but it is hugely unpopular.
Under his law, Obama was to make recommendations for the board last year. The 15-member panel is required to be made up of physicians and laymen, with recommendations made in consultation with congressional leadership. Those nominees would then be subject to Senate confirmation.
It would be a hideous task to ever try to fill that panel, at least without a Democratic supermajority in the Senate. Finding 15 people willing to submit to the confirmation process would be difficult. Finding 15 people who could actually be confirmed would be next to impossible.
And this would hardly be the time to have a conversation about when the government should let people die.
The top priority right now for Team Obama is getting the key component of the law – a new middle-class entitlement program – in place on or near schedule. The doors are supposed to open on the new health-insurance program this fall and problems are piling up.
Senior Senate Democrats who helped build the law, Max Baucus of Montana and Jay Rockefeller of West Virginia, have been sounding the alarm about the halting, confused and complicated creation of such a massive regulatory and welfare program. Republicans, who briefly considered learning to live with the law they hate, see plenty of opportunity to impede and imperil the president’s hallmark program.
With so much discontentment about the implementation of the already unpopular law, the Obama Democrats feel an increasing sense of urgency to get the welfare component of the law in place quickly. Remember that Medicare, now permanent and popular, had 10 percent of all Americans on the rolls at the start of its fourth year. The president’s program has zero enrollees at the same point.
A program with no beneficiaries is an easy one to eliminate, hence the dash to get Obamacare going before the 2014 election cycle begins in earnest. Democrats are already showing willingness to diss Obama on key policy points, most recently the full surrender on sequestration spending levels for the Department of Transportation.
Rather than making it hurt by delaying flights and then trying to blame Republicans, Senate Democrats took away the sting. It was the same on gun control as Obama’s fellow Democrats first neutered and then disposed of the president’s proposals.
So it would hardly be a good time to talk about the costs of the president’s health program and the need to ration care to control costs. Obama’s own law may require that the panel be in place and doing its work, but obeying the law could imperil his larger aims.
Just as he has done in the past on submitting a budget and making his own recommendations for rescuing Medicare, Obama is ignoring the law as it relates to the Independent Payment Advisory Board. And in the case of the board, the upside of flouting the law is even greater.
Under the law, if the board isn’t in place, its powers devolve to Health and Human Services Secretary Kathleen Sebelius. Once mentioned as a rising star in the Democrat Party, Sebelius has lashed herself to the mast of Obama’s law and has been willing to face terrible storms to keep the president’s legacy project afloat even as others jump ship.
Her message in House testimony last week was that the unpopular, controversial panel will be no concern to Obama. The next president will face those problems.
Obama and Sebelius may have found another loophole, but all this avoidance is hardly increasing public confidence in the law. There is a growing, bipartisan sense that despite three years of lead time, Team Obama is not ready to implement or manage the law.
Another missed deadline will not help matters.
Chris Stirewalt is digital politics editor for Fox News, and his POWER PLAY column appears Monday-Friday on FoxNews.com. Catch Chris Live online daily at 11:30amET at http:live.foxnews.com.