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A bipartisan budget deal would repeal part of the Affordable Care Act. Photo: Tom Williams/CQ Roll Call

Everybody wants to control health care costs — until it’s time to actually control health care costs.

Driving the news: The bipartisan budget deal unveiled yesterday in the Senate would repeal the Affordable Care Act’s Independent Payment Advisory Board. It’s merely the most recent time Congress has voted, with bipartisan support, to chip away at programs that aimed to slow the growth in health care spending, or at least help balance the federal checkbook.

The impact: Repealing the IPAB takes away what was initially seen as one of the ACA’s most significant cost-control measures.

  • The IPAB was conceived as an independent, expert board that would make targeted reductions in Medicare payments to doctors, hospitals and other providers — it’s legally prohibited from directly cutting benefits — if the program’s overall spending grows faster than a prescribed rate.
  • No one has ever been appointed to the IPAB, and Medicare spending hasn’t grown fast enough to trigger it, anyway.
  • Still, it’s never sat especially well with lawmakers, who saw it as a usurpation of their power. And providers have always hated it, because its whole purpose is to cut their payments.

It’s not just the IPAB.

  • The budget deal also would "slow down federal efforts to hold providers accountable for reducing Medicare costs," Modern Healthcare reports.
  • Congress has repeatedly agreed to delay the ACA’s tax on expensive employer-based health plans. That’s also a cost-control measure — one of the law’s most powerful, in fact.
  • Under former secretary Tom Price, and with many congressional Republicans’ support, the Health and Human Services Department rolled back several ACA-based pilot programs that sought to control health care spending.
  • Lawmakers have also agreed to delay or freeze the law’s taxes on medical devices and health insurers — which weren’t necessarily designed to control health care costs, but which nevertheless helped make the ACA a net deficit-reducer for the federal government.

The bottom line: One person’s cost control is another person’s pay cut — and that fact will always complicate the execution of these ostensibly shared goals.

Go deeper

2 hours ago - World

World leaders react to "new dawn in America" under Biden administration

President Biden reacts delivers his inaugural address on the West Front of the U.S. Capitol on Wednesday. Photo: Alex Wong/Getty Images

World leaders have pledged to work with President Biden on issues including the COVID-19 pandemic and climate change, with many praising his move to begin the formal process for the U.S. to rejoin the Paris Climate Agreement.

The big picture: Several leaders noted the swift shift from former President Trump's "America First" policy to Biden's action to re-engage with the world and rebuild alliances.

Updated 5 hours ago - Politics & Policy

In photos: The Biden and Harris inauguration

President Biden and first lady Jill Biden watch a fireworks show on the National Mall from the Truman Balcony at the White House on Wednesday night. Photo: Chip Somodevilla/Getty Images

President Biden signed his first executive orders into law from the Oval Office on Wednesday evening after walking in a brief inaugural parade to the White House with first lady Jill Biden and members of their family. He was inaugurated with Vice President Kamala Harris at the U.S. Capitol on Wednesday morning.

Why it matters: Many of Biden's day one actions immediately reverse key Trump administration policies, including rejoining the Paris Agreement and the World Health Organization, launching a racial equity initiative and reversing the Muslim travel ban.

Republicans pledge to set aside differences and work with Biden

President Biden speaks to Sen. Mitch McConnell after being sworn in at the West Front of the U.S. Capitol on Wednesday. Photo: Erin Schaff-Pool/Getty Images

Several Republicans praised President Biden's calls for unity during his inaugural address on Wednesday and pledged to work together for the benefit of the American people.

Why it matters: The Democrats only have a slim majority in the Senate and Biden will likely need to work with the GOP to pass his legislative agenda.