House Votes to Kill a Medicare Cost Control Board WASHINGTON - In a rebuff to President Obama, the Republican-controlled House passed a bill on Thursday to abolish a Medicare cost control board created by the new health care law. The bill, approved by a vote of 223 to 181, provoked a full-throated debate on the merits of the law, the Affordable Care Act, on the second anniversary of its signing by Mr. Obama. In dozens of speeches, Congressional supporters and opponents of the law previewed arguments that will be made next week when the Supreme Court hears a challenge to its constitutionality filed by 26 states. The Obama administration, eager to showcase benefits of the law for consumers, said it had found that insurance rate increases affecting more than 42,000 people in nine states were unreasonable. Kathleen Sebelius, the secretary of health and human services, reviewed the rates using authority provided by the new law. She said Thursday that insurers should rescind the increases, issue refunds to consumers or publicly explain their refusal to do so. Insurers said the higher rates were justified by rising medical costs. The stated purpose of the new panel, the Independent Payment Advisory Board, is to "reduce the per capita rate of growth in Medicare spending." Spending cuts recommended by the 15-member board would take effect automatically unless Congress voted to block or change them. "The Independent Payment Advisory Board encompasses all that is wrong with the Affordable Care Act," said Representative Michael C. Burgess, Republican of Texas. It is not accountable to any constituency, and it exists only to cut provider payments to fit a mathematically created target. The House vote generally followed party lines. Seven Democrats voted for the bill, and 10 Republicans voted against it. A number of powerful House Democrats dislike the board because, they say, it could usurp the power of Congress to set Medicare policy. But most Democrats voted against the bill because it also included proposals that could limit patients" ability to recover damages for injuries suffered as a result of medical malpractice. In the Senate, Republicans said they would push for similar legislation, perhaps by offering amendments to other bills. Senate Democrats vowed to block such efforts. Representative Allyson Y. Schwartz, Democrat of Pennsylvania, said she wanted to eliminate the board because lawmakers should "take responsibility for Medicare." But Ms. Schwartz said Republicans had destroyed any hope of bipartisanship by "linking repeal of the board to tort reform, an unrelated, divisive and polarizing issue." Representative Pete Stark of California, the senior Democrat on the Ways and Means Subcommittee on Health, said that he, too, opposed the board, but that it was "far less dangerous to Medicare than the voucher plan put forth in the House Republican budget this week." The White House threatened to veto the House bill and defended the payment advisory board, saying it "will help reduce the rate of Medicare cost growth responsibly while protecting beneficiaries." Under the law, the board cannot make recommendations to "ration health care," raise revenues or increase beneficiaries" premiums, deductibles or co-payments. Republicans said the board would inevitably try to save money by cutting Medicare payments to doctors, who would then be less willing to treat Medicare patients. "I have been a practicing physician for over 15 years, and I don't think I have seen anything potentially more detrimental to seniors" health care than the Independent Payment Advisory Board," said Representative Larry Bucshon, Republican of Indiana and a heart surgeon. No president should have the power to create a board with this much control over health care. Representative Alcee L. Hastings, Democrat of Florida, said: "I am appalled by the hypocrisy of my Republican colleagues who keep stating that federal spending needs to be kept under control. But at the first opportunity, they wind up rejecting one of the most serious tools in place to actually tackle Medicare spending and make care more affordable. The Congressional Budget Office estimated that repealing the board could increase Medicare spending by a total of $3 billion from 2018 through 2022.