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 rates.
           
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 HME;
--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 outlays;
--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 care.”
 
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 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 Americans.”
 
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 bill.
 
“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 MedPAC Reform Act of 2009.
 
View the White House IMAC draft legislation.