House Democratic leaders have struck a tentative deal with their fiscally conservative members on health care reform, agreeing to a proposal that would vastly expand the powers of an independent agency to cut benefits for older Americans.
Speaker Nancy Pelosi said there was “no question” she now had the votes to pass a health care reform, although some Democratic moderates said there were still holdouts that could block passage.
Pelosi, President Barack Obama and House Energy and Commerce Committee Chairman Henry Waxman, D-Calif., struck a deal with the fiscally conservative Democratic Blue Dog Coalition to expand the powers of the Medicare Payment Advisory Commission, or MedPAC, an independent congressional agency established in 1997.
The agency advises Congress on Medicare payment policies and other issues related to the program, but it currently has no power to implement its recommendations.
Under language that will be added to the House bill, MedPAC would be able to set reimbursement rates and make other reforms without congressional authorization.
The proposal has yet to be formally written, but according to those familiar with the matter, the agency would first have to make recommendations to the president, who would then decide whether to send them along to Congress. Congress would have 30 days to vote against them before they went into effect.
Democratic leadership aides concede they may face opposition from their more liberal faction over the proposal, but said they had to make the concession in order to bring in the Blue Dogs, who demanded cost controls in the $1 trillion-plus proposal.
The idea of expanding MedPAC’s power is not new, having floated around the Senate in various forms for years, but Congress has had little appetite for ceding any of the power it has over Medicare’s purse strings.
But it could be one of the concessions necessary to draw in the moderate Democrats needed to pass the bill in both chambers.
Sen. Ben Nelson, D-Neb., a moderate who has not pledged support to any health care bill, called the MedPAC provision “an interesting idea.”
The proposal is drawing criticism from some experts. Gail Wilensky, who was the chairwoman of the MedPAC board from 1997 to 2001, told The Examiner that the move would provide “too much power and too much authority” to the board, which not only sets reimbursement rates for doctors, but plays a pivotal role in deciding other reforms, such as how to reorganize physicians and hospital groups together to provide services.
“It makes me nervous,” Wilensky said. “I don’t like the notion of having decisions this important to this many individuals either as providers or receivers of care, to a group that is unaccountable to the public.”
