By loudly refusing to make nominations (as they are entitled to do under the terms of the Affordable Care Act) to the Independent Payment Advisory Board charged with identifying Medicare cost savings, Speaker John Boehner and Senate Minority Leader Mitch McConnell are signaling a new and toxic phase in the war on health care reform. TPM’s Sahil Kapur has the essential background:

The top two Republicans in Congress informed President Obama on Thursday that they will refuse to fulfill their duty under the Affordable Care Act to recommend members of a new board with the power to contain Medicare spending.

It’s a dramatic power-play driven by the explosive partisan politics of Obamacare and with potentially important implications for federal health care policy.

In a letter to President Obama, House Speaker John Boehner (R-OH) and Senate Minority Leader Mitch McConnell (R-KY) noted their original opposition to Obamacare, reiterated their intent to repeal it entirely, and declared that they would not make any appointments to the Independent Payment Advisory Board.

The IPAB is a 15-member panel whose members must be confirmed by the Senate. The President selects three members himself and is required by law to seek three recommendations each from the top Democrat and Republican in each chamber. With Thursday’s letter, Boehner and McConnell refused to make any recommendations.

The IPAB will be stood up in 2014 by Obamacare and tasked with making cuts to Medicare provider payments (it may not touch benefits) if costs exceed economic growth plus an additional percentage point in any given year. Congress can override it by passing equally large cuts with a simple majority or waiving the cuts entirely with a three-fifths majority.

“Because the law will give IPAB’s 15 unelected, unaccountable individuals the ability to deny seniors access to innovative care, we respectfully decline to recommend appointments,” Boehner and McConnell wrote in the letter.

Keep in mind that IPAB is essentially a beefed-up version of the MedPAC panel created in the 1997 Balanced Budget Act at the urging of congressional Republicans. While MedPAC made recommendations that were routinely ignored by Congress, any cost-savings measures recommended by IPAB take law unless they are vetoed by Congress.

But forget the details: IPAB is the “death panel” famously denounced by Sarah Palin in her massively influential shout-out to the antichoice movement and its eternal claims that secular socialists want to follow up legalized infanticide with wholescale euthanasia against the disabled and elderly. IPAB is also, of course, a convenient target for the immensely hypocritical but nonetheless powerfully repeated Republican attack on “Obama’s Medicare cuts,” in turn a not-so-subtle effort to convince comfortable white seniors that Democrats want to take away their hard-earned government health care benefits and give them to those people, the riffraff on “welfare.”

In other words, IPAB is at the beating heart of the entire attack on Obamacare. So not only will congressional Republicans resist cooperation in its creation: they are certain to launch filibusters in the Senate against any actual presidential nominations.

The irony is that in the absence of IPAB the administration is empowered to issue its own Medicare cost-savings recommendations. But ultimately, this isn’t about health reform policy, or for that matter, about Medicare or even ACA. It’s a full-on Republican attack on the president using, in tandem, every major weapon in the arsenal: lies, hypocrisy, and of course, the filibuster. It could prove to be an epic rumble.

Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.