Perhaps the two aspects of Donald Trump’s presidency that I admire the most are is ability to go around supposedly immovable blocks to his proposals and the way he stiffens the spines of his fellow Republicans.

After the humiliating Obamacare repeal failure of 2017, many weaker men would have moved on to other matters. However, as Trump continues to take a giant eraser to Obama’s legacy, he has obviously moved Congress to take a more piecemeal approach to ending the onerous health insurance regulations promulgated under his predecessor.

The unpopular mandate to purchase health insurance died when the tax reform package was passed in December. This week, congressional Republicans pulled the plug on the Independent Payment Advisory Board (IPAB), which Republicans have tagged as the “Death Panel”.

The 15-member board has always been more theoretical than actual. Medicare spending has grown at record-low rates in the years since the bill passed, meaning that its use has never been triggered…And the Obama administration, eager to avoid a political fight over the board, didn’t nominate a single person to sit on it. Neither has the Trump administration.

The idea behind the IPAB was that Congress often has little appetite for cost control. So, the thinking went, if Medicare spending took off, the board would develop a plan to get that spending back under control. If Congress hated the idea, it could pass an alternative that saved the same amount by a deadline — or ignore the cuts altogether if it could muster a supermajority vote to do so. But if it did nothing, the board’s will would become law.

…But the idea was never particularly popular, even in the Congress that voted for it. The IPAB would have taken away Congress’s power to make the cost-saving choices it wanted — or its choice to avoid them.

Joe Antos, health-care scholar at the American Enterprise Institute, has this analysis on the move:

The big problem with repealing the IPAB is this is a Congress — and it’s bipartisan — that has no interest in fiscal responsibility. It was only put in to produce savings, but there was never any intention from the very beginning to actually allow it to operate. It was a lot like many of these automatic savers in the Medicare program — they were never really meant to work.

This was never going to get off the ground and so the point of this was really a fraud to begin with, which was to claim this was a way of paying for the ACA.”

Because of the reduce cost controls, the Congressional Budget Office (CBO) asserts that repealing the IPAB would cost the federal government $17.4 billion over the next decade. But since the CBO also projected that Obamacare was fiscally responsible and reduce the deficit, I am not too sure I trust its recent calculations.

However, the joy I have at seeing another piece of Obama’s pen-and-phone legacy erased is priceless!


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