End of Filibuster Could Boost Obamacare

The president now has the means to fire those responsible for the roll-out debacle. REUTERS/Gary Cameron

The ending of the filibuster in the Senate will do far more than speed President Obama's judicial appointments. It could also help him rescue his stumbling, bug-ridden health care reforms.

Filibuster reform will allow Obama to use appointments to push through his second-term priorities. That includes implementing one of the most controversial provisions of the embattled Obamacare.

By eliminating the filibuster for executive and non-Supreme Court judicial nominees, President Obama now has wide latitude to appoint a raft of senior health care officials to carry out his law – and to fire officials who presided over the rollout disaster or who are hindering its successful implementation.

The most controversial move the president could make is to appoint members of the Independent Payment Advisory Board (IPAB), a controversial panel set up by the Affordable Care Act to rein in Medicare costs by cutting payments to doctors if Medicare spending grows too quickly.

Members of both parties have criticized the board for giving too much authority to unelected officials because Congress has little power to stop its recommendations from taking effect. The board's proponents say that is the point. It will take cost-cutting decisions out of the hands of politicians who don't have the appetite for taking tough spending decisions.

Right now, Medicare costs are not rising at a rate that would trigger IPAB action, and the president also may not want to open a second front in the battle over Obamacare by making appointments before the 2014 midterm elections.

But he will have to make the appointments eventually, as the IPAB is key to reforming the costs of health care as a whole.

"IPAB is part of the Affordable Care Act's commitment to assuring all Americans quality care at lower cost," Judith Feder, a health care expert at Georgetown University, told Congress in 2011 .

"Having IPAB as a backstop to sustain Medicare's financing is not only critical to securing this vital program that makes health care affordable for older and many disabled Americans," she said, "but also to assure that Medicare leads the much-needed transformation of the nation's entire health care payment system."

But making appointments isn't the only new power Obama has acquired under the new Senate rules. The end of the filibuster also gives him the means to fire people.

As he was not certain he could get a nominee through the Senate, the president has until now been hesitant about firing people because he could never be assured he would get a suitable replacement.

Some are already calling for firings at the Department of Health and Human Services over the disastrous rollout of Obamacare. If the president feels it's necessary – or politically expedient – he is now in a position to accept the resignation of HHS chief Kathleen Sebelius or another top HHS official because he can be sure to be able to replace them.

"HHS Secretary Kathleen Sebelius may lose the most from the Senate's rule change on the filibuster. And the Affordable Care Act may be healthier for it," John Hudak, an expert on presidential power at the Brookings Institute, wrote Thursday after the rule change. Though there appear to be problems at HHS, he wrote, while "the president faced the prospect of long-term vacancies among appointees overseeing ACA, the HHS leadership would be spared."

But don't expect a firing spree any time soon. "With the website problems and exchanges, the problem is so complicated that if people haven't been involved with it previously working on it, I think it will be very hard for outsiders to come in and be able to move things along quickly that they don't have that built up knowledge [of]," warned David Howard, a health policy expert at Emory University.