Executive Session

EXECUTIVE SESSION

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Mr. BARRASSO. Mr. President, I come to the floor, as I have week after week since we passed the health care law, giving a doctor's second opinion of the law. I come today because last month President Obama delivered a very big speech on spending. Unfortunately, it seemed to be more of a political attack than a substantive speech offering a detailed plan to attack the American debt crisis.

The President did, however, mention one bit of substance that really should raise a red flag to the American people. He said:

We will slow the growth of Medicare costs by strengthening an independent commission.

Well, the Washington commission he is referring to is called the Independent Payment Advisory Board. This board may sound harmless, but let me assure you that the American people deserve to know and have a right to know more detail about the board and its work.

Many Americans may not remember that the health care law created this unelected, unaccountable board of Washington full-time bureaucrats. The sole purpose of the board is to cut Medicare spending based on arbitrary budget targets--not based on the number of people on Medicare or the number of seniors but based on arbitrary budget targets. These are cuts above and beyond the $500 billion already taken from a nearly bankrupt Medicare Program during the health care law--taken from our seniors--not to save Medicare but to start a whole new government program.

Now the President wants to slow the growth of Medicare costs by strengthening this independent commission. Well, this board empowers 15 unelected Washington bureaucrats to make these Medicare cuts, all without full transparency and accountability to the American seniors and also to elected officials.

Once again, this board proved that the President and the Democrats in Congress who voted for the health care law simply didn't have the political courage to make tough spending decisions. Instead, they took the easy road and pulled a classic Washington maneuver: they created a board and then punted the tough decisions to the board. Well, this forced Congress to abdicate two important congressional duties. First is the constitutional responsibility to manage Medicare spending. The second is the responsibility to explain to the American people why specific payment changes might be necessary to keep Medicare afloat--all because the President and Washington Democrats refused to lead. They simply threw up their hands and said: Let someone else deal with it.

If expanding this independent board is--they call it ``independent,'' but I am not so convinced it is. It is called the Independent Payment Advisory Board. If expanding the board is the one and only concrete proposal the President has to reform Medicare and reduce the debt and most Americans have never even heard of it, then it is important that we take the time on the Senate floor today to discuss exactly how this board works and the impact it will have on medical care in America.

I call this the top 10 things you need to know about the Independent Payment Advisory Board. To me, this issue is so important that I plan to talk about five of them today, and I will come back next week, as part of the doctor's second opinion on the health care law, and talk about the next five.

No. 1, this board is how Washington will limit patient care.

When Congressman Paul Ryan offered his 2012 budget plan, the President and members of his party launched an all-out media assault on Medicare spending. The White House and Democrats used inflammatory and patently false statements to scare people about the Ryan plan. What they failed to mention, however, is that the President's own health care law actually has significant caps on Medicare spending. To enforce the caps, the President and Washington Democrats went with their tried-and-true solution: create another board.

What does this mean for people who are currently on Medicare and for future Medicare patients? A centralized Washington board will arbitrarily cut payments to Medicare providers--doctors, nurses, and other people taking care of patients. They are going to squeeze Medicare savings by cutting provider payments and treatment options, which will punish patients. Why? To start a whole new government program--not for the people who paid into Medicare but for a whole different group of people. Not only will medical professionals facing these cuts decide to simply stop seeing Medicare patients--and we see that now. Frankly, doctors are running away from Medicare, not wanting to see those patients. Individuals and families will watch helplessly as a Washington bureaucrat decides what kind of treatments that person can have.

No. 2, this board is going to make recommendations, and those recommendations will automatically become law.

How can it be that something the board does automatically becomes law? But their spending recommendations automatically become law--unless Congress acts to stop it. If Congress would actually want to stop the board's policies, there are very few options. The options are severely limited. Overriding the board's recommendations requires a three-fifths majority vote in the Senate, a high hurdle to jump, or Congress can pass a different Medicare spending plan. But there is a catch. It still has to meet the same arbitrary spending target. So if Congress does nothing, then Health and Human Services Secretary Kathleen Sebelius will implement the board's plan.

Medicare consumes about 13 percent of the Federal budget, and former Office of Management and Budget Director Peter Orzag called this board ``the largest yielding of sovereignty from Congress since the creation of the Federal Reserve.''

The bottom line is that this board isn't making recommendations to Congress; this board is passing law. Well, Congress doesn't have to approve these policies of the board, and the President

doesn't have to sign them. They are law. This represents an unprecedented shift of power from the legislative branch of the Federal Government to an unelected board of 15 bureaucrats.

No. 3, the policies of this board cannot be challenged in court.

On April 19 of this year, the New York Times published an article entitled ``Obama Panel to Curb Medicare Finds Foes in Both Parties.''

This article explains that:

In general, federal courts could not review actions to carry out the board's recommendations.

Well, there is an institute called Arizona's Goldwater Institute. They filed a lawsuit based upon this payment advisory board. Part of the lawsuit says:

Congress has no constitutional power to delegate nearly unlimited legislative power to any federal executive branch agency, much less to entrench health care regulation against review, debate, revision, or repeal. ..... Such federal overreaching must be rejected if the principles of limited government and the separation of powers by the United States Constitution mean anything.

That is what the lawsuit says.

Let's go to No. 4. This board's mission is to cut provider payments. The board is strictly limited in what it can do to achieve Medicare spending reductions. By law, the board cannot raise revenue by increasing taxes. It cannot increase patient cost-sharing methods, such as premiums, copayments, and deductibles. It cannot alter Medicare eligibility or benefit package.

What can it do? One thing and one thing only: It will adjust provider reimbursement rates. We all know Medicare payment rates are already well below market rates. That is why so many doctors are limiting the number of Medicare patients they see and, in more severe cases, refusing to treat Medicare patients at all.

Additional subjective cuts to Medicare will not make the program more efficient or more available. These measures will simply reduce the supply of medical care to the Medicare patients of America.

The Medicare Chief Actuary, Richard Foster, warned us that the health care law's Medicare cuts would cause providers to leave the program, and we are seeing that today. It is not because they do not want to treat Medicare patients; it is because the doctors know the payments will be too low to even cover their costs. Mr. Foster, the Medicare Chief Actuary, has said approximately 15 percent of our Nation's hospitals would drop out of Medicare in 10 years.

Then No. 5: This board could eventually impact all patients, not just Medicare patients. Washington Democrats have long supported policies that give government more power to set health care prices, not just in public programs such as Medicare, but also in the private sector. President Bill Clinton asked for this authority in a 1994 debate on what at the time was called ``Hillary care.'' It was one reason his effort failed. President Obama learned from that failure. Make no mistake, he wants to achieve the same objective. This time he is using this board as a Trojan horse to sell it.

If President Obama's health care law remains the law of the land, millions of Americans will have government-subsidized health insurance. Paying for this new entitlement program will cost trillions. It will be no surprise when we inevitably hear cries for increased cost control. This is when the President will make his move--proposing to extend this board's reach beyond Medicare to the new health care law's subsidized insurance premiums. Last month, the President opened the door to this strategy when he proposed in his speech to expand this board's power and its control over Medicare.

That is why I come to the Senate floor each and every week to deliver a doctor's second opinion about the health care law--a law that I believe is bad for patients, bad for providers--the nurses and doctors who take care of those patients--and bad for our taxpayers. I believe the more the American people discover about this so-called independent payment advisory board, the more unpopular the President's health care law will become.

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