Weren't House Republicans Worried About Medicare Costs? As part of their broader campaign to repeal health care reform, House Republicans are determined to kill off an independent board that is supposed to help rein in federal spending on Medicare. Their rhetoric is predictably distorted: charging that "15 unelected bureaucrats" should not be able to "ration care." In truth, the independent payment advisory board of nongovernmental experts is specifically precluded from rationing care, and Congress, not the board, has the final say on what cuts should be made. The Congressional Budget Office estimates that repealing the board would drive up federal spending on Medicare by $3.1 billion over the course of a decade, but the board is especially important as a longer-term backstop against rising costs. Nevertheless, the repeal bill has already passed two committees, with some Democratic support, and it is likely to pass the full House this month. A repeal bill pending in the Senate seems unlikely to pass, but there are no guarantees in an election year. The reform law requires the board, starting in 2014, to make recommendations to reduce federal spending on Medicare whenever its growth rate is projected to exceed a specified target. The board is not only prohibited from making proposals that would ration care, it cannot call for changes in Medicare benefits or eligibility, or increases in premiums or cost-sharing. Instead, it will have to rely on cutting payments to health care providers. That is the slim basis for Republicans to argue that - if payments are cut too deeply - many providers may stop accepting Medicare patients and those patients will have their access to care "rationed." However, a separate board of experts advises Congress whenever access is threatened and suggests ways to preserve it. The board will include doctors, consumers and patient advocates who will be proposed by Congressional leaders, nominated by the president and confirmed by the Senate. Its recommendations would become law unless Congress approves alternative, equal savings. Many Congressional critics complain that the board will usurp their authority. But the board's prime role is to serve as a buffer between Congress and the powerful health care lobbies that drive up spending. Congress certainly needs the help.