WASHINGTON—In a move that could help break the stalemate
over the House health care reform bill, President Barack Obama and
seven conservative Blue Dog Democrats agreed in a meeting Tuesday
to work toward an independent body to establish Medicare payment

Wary of the cost of the proposed reform bill, which is currently
undergoing markup by the House Energy and Commerce Committee, the
Blue Dogs have delayed the process, saying the bill does not do
enough to rein in costs among a host of other disagreements. The
committee is scheduled to continue its markup today; the House Ways
and Means and Education and Labor committees have already approved
the bill.
The Congressional Budget Office has said creation of an independent
council could help reduce costs, according to Arkansas Rep. Mike
Ross, who attended the White House meeting. Ross, a former HME
owner, chairs the Blue Dogs’ Health Care Task Force.
While the Obama plan is not completely fleshed out, it has merit,
according to Ross.
“It’s in the infant stages, but I think it’s a
significant breakthrough,” Ross told reporters.
Obama, who is pushing to get the health reform bill through the
House, last week called for the creation of what he dubbed the
Independent Medicare Advisory Council. Sort of a MedPAC with
muscle, the IMAC would have the authority to establish Medicare
payment policy and rates, including for home medical equipment. The
current Medicare Payment Advisory Commission is limited to making
recommendations to Congress, which the President said are largely
ignored and end up “sitting on a shelf.”
“What we want to do is force Congress to make sure they are
acting on these recommendations to bend the cost curve each and
every year,” Obama said.
While its components have not been determined, in his legislative
proposal for the new council Obama suggested that it:
--Have authority to establish Medicare payment rates and policy
that could only be overturned by congressional resolution;
--Provide two sets of recommendations annually, one by Oct. 1 that
would focus on payment systems operating on a fiscal-year basis,
the other by Dec. 31 for calendar-year systems, including
--Be comprised of five paid members, physicians or experts in
health policy, appointed to five-year terms by the President with
the consent of the Senate;
--Be restricted from increasing the aggregate level of net Medicare
--Go into effect Sept. 15, 2014.
“IMAC would issue recommendations that would either improve
the quality of medical care provided to Medicare beneficiaries or
improve Medicare’s efficiency,” according to Peter
Orszag, director of the White House Office of Management and
Budget, speaking before the Council of Foreign Relations on
Wednesday. “After being approved as a package by the
President, the recommendations would take effect unless explicitly
voted down by the Congress within 30 days.”
Orszag said empowering such a council was “imperative for two
reasons. First, it would help to insulate Medicare policy decisions
from undue political influence, while at the same time preserving a
say for our democratically elected representatives. Second, it
would help us keep up with the ever-evolving health care market and
continually re-orient it toward higher quality and more efficient
The White House did not indicate a budget for the new entity, but
according to The Associated Press, the current MedPAC
includes 17 part-time commissioners and a staff of 36 working
within a $10.4 million budget and housed on one floor of a
government building close to the Capitol.

Earlier, Orszag said the White House would also be open to
boosting MedPAC’s authority to a similar level, a proposal
made by Sen. John D. Rockefeller IV, D-W.Va. In May, Rockefeller
introduced the MedPAC Reform Act of 2009 (S.1110), which would
elevate MedPAC to an executive branch agency with the authority to
implement Medicare payment policy.

In a July 17 target="_blank" title="letter">letter to House Speaker
Nancy Pelosi, D-Calif., Orszag wrote: “Either the Rockefeller
proposal or the [IMAC] legislation would represent a critical step
forward in creating a health care system that rewards quality,
restrains unnecessary costs and provides better care to more
But while Energy and Commerce is on board, other Democrats
apparently aren’t so happy with the proposal, according to
press reports.
Rep. Pete Stark, D-Calif., chairman of the Ways and Means
Subcommittee on Health, hammered the idea. The IMAC proposal is
“stupid at best, unworkable, childish, idiotic,” he
told reporters, adding that it would remove the committee’s
constitutional authority over programs related to taxes and anger
the doctors, hospitals and unions that favor the health reform
“Every major provider group in the country is calling us up
and screaming and saying they will oppose the bill if the IMAC
thing goes through,” he said.
View the text of the target="_blank" title="MedPAC Reform Act of 2009">MedPAC Reform Act
of 2009
View the White House IMAC target="_blank" title="draft legislation">draft