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Obamacare “Death Panel” killed

Obamacare “Death Panel” killed

Ding, dong, “Independent Payment Advisory Board” is dead!

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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The nation’s debt will eventually ruin us, and everybody knows it. Oddly, Trump hasn’t lifted a finger to stop the spending. I guess that’s a job he’ll leave to the next guy.

    villiewe in reply to Matt_SE. | February 9, 2018 at 9:47 pm

    Have you made a comparison of Zimbabwe or Venezuela or Weimar Germany money supply creation and determined where the US is on the history of those well known excessive debt cycles?
    What is your best guess when the US debt level triggers catastrophe?

      notamemberofanyorganizedpolicital in reply to villiewe. | February 10, 2018 at 3:31 pm

      When you owe the bank a Million, the bank controls you.

      When you owe the bank Trillions and Trillions and Trillions, you own the bank – and the rest of the world!

    Yes and No. The Trump policy appears to be much as the Reagan policy was: GROW your way out of the debt.

    If your rate of growth is faster than the increase of expenditures, then you are reducing debt load (it’s the same size slice of a “larger” pie). But, it does require that you don’t increase spending commensurate to the increase of total growth.

    I’m a big fan of the penny plan and the FairTax. Between those two, the spending would come under control, and growth would be sufficient to make principle payments.

Matt, while I agree, at this moment in time it’s like fixing a leaky faucet in the midst of Hurricane Katrina.

    Most important – don’t forget what the spending is for: entitlements. In other words, democrat votes.

    But, this is all temporary – we’re one democrat president away from it all coming back.

    Obamacare needs to be repealed. If the likes of mcconell, ryan, etc. are trampled and left on the side of the road as repeal comes charging through, all the better.

The only way to stop the spending is to cut entitlement spending – not typically the most popular thing to do before a midterm election.

R.I.P. and never come back.

Fiscal sanity may begin to return when the bond market comes back to life. Remember the 1990s “bond market vigilantes”? They will return as interest rates rise and make our debt payments more painful to pay.

Great stuff. These are the little things that matter a lot.

It’s inaccurate to say Trump has done nothing about “debt.” He’s not been filling all vacancies, he’s rolled back regs such as all the weather-related crap, et cetera. I believe the fed. govt. is spending less now than when the Kenyan was in office. Nothing against Kenyans, they’re great people.

I believe he is tightening the belt in a hundred different ways, or maybe a thousand, and it’s having an effect. But it takes a while to turn a big ship. Have you heard how many people they’ve fired in the V.A.???? Huge numbers. If he does a similar thing with civil service reform, we may have a great savings on our hands.

I’m sure he’ll find many ways to tighten the belt. He’s already doing great things.

Now, if he would just crowdfund the damn Wall, so it could be built, I’d believe he walks on water.

Repealing IPAB is a step in the right direction. Costs are going up in great part because a layer of federal regulation of insurance has been laid on top of state regulations. Removing that and permitting more competition is how costs could be controlled.

OleDirtyBarrister | February 10, 2018 at 12:16 pm

The mandate on employers still exists.

The mandates from HSS on insurers on policy provisions still exists.

The former would have to be repealed by Congress. Trump can do something about the latter by taking regulatory action to create more tiers of compliant policies, and to allow policies for secondary and tertiary coverage in case of chronic illness and inability to work and maintain insurance coverage. Of course, the risk of doing that is fixing and owning )-care. So I’d settle for weakening the mandatory requirements.

Without the individual mandate, it is cheaper to own a non-complying policy if one can find one in his/her state because there is no longer a penalty. But employers could use some relief right along with their employees that have worse coverage.

Placing my father in a skilled nursing facility (SNF) last summer has taught me about death-panel-like policies of Medicare. After what appeared to be a stroke, we were assured he had 100 days of Medicare paid SNF coverage. But after less than 60 days in the facility, the nursing staff processed a “Notice of Medicare Non-Coverage” (NOMNC) form claiming he no longer met requirements for Medicare SNF coverage. That forced him into a private pay situation, until he was spent down sufficiently for Medicaid to take over.

Turns out there was a decision in 2013 “Jimmo vs. Sebelius” which held that the Medicare improvement standard could no longer be used to punt patients who “failed to improvement” from Medicare. It was successfully argued that elderly patients receiving covered therapy might improve, remain the same, or even decline under therapy – nevertheless it was beneficial to the patient for maintaining skills and mobility, or simply to slow deterioration.

But generally speaking, SNFs have been slow – even resisting – adopting the Jimmo v. Sebelius decision and attendant Medicare changes (on CMS.GOV) – leaving enforcement of the decision to individuals to sue for benefits. The net result for my father, has was punted for “failure to improve” under the old standard, has had death-panel like effect on him. With therapy he was holding his own – without therapy, his decline has hastened.

Anyway – just want to point out that death-panel type decisions have been made since long before Obamacare – and the government (Medicare) is only too happy to benefit economically from it. From this knothole – my father’s life sold down the crapper for $15,000 in savings to Medicare and the opportunity to plunder his small IRA for private pay.

notamemberofanyorganizedpolicital | February 10, 2018 at 3:26 pm

Love your wording of things Leslie!


“Obamacare “Death Panel” KILLED”

“Pulled the Plug!”



    I am grateful for editors who allow me to include as much snark as possible in each post!

      “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…”

      Amazing how easy it was for him, isn’t it? Sure, it took was nerves of steel and a brain like a trap – but most of all, it was stating the flying obvious.

      Donald Trump is to the nation what the repeal of The Beast of Obama’s ‘school lunch program was to hungry school kids. Both groups were starving for the likes of Trump and for the Beast to have her fat, gluttonous ass booted out of power.

        “…he stiffens the spines of his fellow Republicans…”

        Leslie, Trump doesn’t stiffen their spines of the GOPe hacks infesting Congress any more than the ‘barrier’ troops of the Soviet Union stiffened the spines of their deserting soldiers: in the Soviet time, deserting soldiers either fought or got shot by their superiors while retreating. in the present case, the GOPe has a choice: face pelosi and schumer, or they can face Trump. Trump scares them worse. It says worlds about Trump being great, but also says worlds about the cowardice and corruption of the GOPe. We need to get rid of them.

        ‘Barrier Troops’ of the Soviets: