Whatever Happened To The "Death Panel"?

Obamacare's Independent Payment Advisory Board, derided by critics as a rationing board, still doesn't exist. The administration says health care costs are slow enough, so recommendations to keep costs down won't be needed until at least 2017.

WASHINGTON — Not long ago, there was a surge of momentum on Capitol Hill to kill the Independent Payment Advisory Board — dubbed the "death panel" by GOP critics of the law.

But now they may not need much help: These days, the IPAB effectively doesn't exist.

The board, tasked with producing solutions to keep Medicare costs low, was supposed to start work this year. None of the board's 15 members has been put in place — no one has even been nominated. The omnibus budget signed into law last week slashed $10 million from its budget. And now, because of reported slowing health care spending levels, there are questions about when it will even be even necessary.

There's been nary a peep about the IPAB, too, either from the administration or from Congress.

Like so many Obamacare provisions, repealing the IPAB was once a prime target for Republicans hammering the law. Supporters argue the IPAB is a key method of reducing health care spending; critics call the IPAB a rationing board, claiming it will ultimately limit care to seniors, though the law stipulates the IPAB can't make recommendations that will lead to rationing. Unlike other key provisions of the law, though, repealing the IPAB found support with a good number of Democrats.

That bipartisan scorn has politicized what the IPAB's supporters argue is an essential piece of the cost control puzzle: to actually take the politics out of the decision making process.

"The idea of having a quasi-independent board, look at health care spending is one that has been on the table for a long time," said Tricia Neuman, a Medicare expert and senior vice president at the Kaiser Family Foundation. "There is some value in some having some people think independently and understand what's driving health care spending and think about ways to slow the growth… but the IPAB is certainly a lightening rod."

Rep. John Fleming, a GOP doctor, posited that the president would wait at least until after the 2014 midterm elections before moving on any nominations.

"The president is sort of operating this law on the fly," Fleming said. "I suspect there's a political downside to it and he's going to wait until after the 2014 elections. That's been his pattern in the past. It's a huge political issue and the last thing in the world they need is to start talking about IPAB."

With last year's rule changes, conceivably the administration could push nominees through the Senate — but that would likely be a difficult vote for Democrats facing tough reelections.

There's an even bigger question, however: Is the IPAB even needed right now? A report issued last year concluded both that health spending has slowed and that no recommendations from the IPAB would even be necessary.

Conceivably, had Medicare spending gone up, the IPAB would have had to make recommendations this year to slow spending growth — and considering the IPAB does not exist, the secretary of Health and Human services would have made them instead. The good news for the IPAB's supporters and opponents alike is that it will probably be a while before the panel's existence even becomes necessary.

"Two things happened this year: There haven't been any appointments, but what did happen is the actuaries were required to issue a report to say whether was spending was projected to exceed the target and they did and they said it wasn't," Neuman said.

An administration official told BuzzFeed there were no updates on nominations of appointees, but stressed that health care costs were growing at a slow enough rate that IPAB action wouldn't be necessary for a long time.

"Recent slower growth in health care costs means action would not be needed until 2017 according to the Medicare Trustees and CBO does not predict recommendations would be needed at all between now and 2023 (current budget window)," the official said in an email.

Among the most ardent critics of the IPAB, though, the fervor hasn't died.

Rep. Phil Gingrey, a Georgia Republican and doctor, was an original co-sponsor to the House bill to repeal the IPAB. He argued that that the rocky roll out of the health care law itself distracted from slashing things like the IPAB. Gingrey has previously said that the board will cause seniors to die.

"I don't think the issue has gone away one iota. The absolutely fiasco of the roll out continues, so why take the spotlight away from that?" Gingrey said. "When and if that's ever fixed than the spotlight's certainly going to go back to IPAB."