John Boehner Mitch McConnell smile
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One of the most politically intense fights over the Affordable Care Act was over the creation of the Independent Payment Advisory Board, infamously dubbed a "death panel" by Republicans during the 2010 elections. 
On Thursday, Republican House Speaker John Boehner and Senate Minority Leader Mitch McConnell signaled that they would keep working to keep opposition alive by doing everything they can to impede the board's implementation. 
The two leaders wrote a letter to President Barack Obama, notifying him that they would not be submitting any recommendations to the panel because of their opposition to it and to the law in general. 
Here's the relevant part of their letter explaining why they aren't offering any recommendations:
In order to allow supporters to claim that the law’s Medicare cuts would be realized in the future, it tasked IPAB with reducing payments to providers or eliminating payments for certain treatments and procedures altogether.  These reduced payments will force providers to stop seeing Medicare patients, the same way an increased number of doctors have stopped taking Medicaid patients.  This will lead to access problems, waiting lists and denied care for seniors.
The unfortunate result is that decisions which impact America’s seniors will be made in the absence of the democratic process, without the system of checks and balances that would normally apply to important matters of public policy.  Yet your recent budget called for expanding IPAB by tasking it with making even larger cuts to Medicare than those called for in the health law, even though the trustees of the Medicare program have told us that IPAB’s provider cuts would be “difficult to achieve in practice,” because of the denied care that seniors would experience.
Though the move will likely play well for Republicans politically, it won't have much of an effect on the implementation of the health care law, at least for the foreseeable future, according to health care law professors. 
The IPAB is set up to be a 15-member panel. Three members will be chosen by the Republican leaders of the House and Senate, and the remaining three are chosen by Obama and the executive branch. All of the members have to be confirmed by the Senate.
But the IPAB is only needed if Medicare costs are projected to go beyond economic growth plus an additional percentage point in any given year, said Allison Hoffman, an assistant professor of law at UCLA. Right now, Medicare costs aren't growing fast enough to require the board to decide which cuts to make to Medicare providers.
"There's actually no work for the IPAB to do this year," Hoffman told Business Insider. 
McConnell and Boehner's letter has "no impact on the ground," Hoffman said. "It's a protest move. You know — we're not going to cooperate with what the law says in this regard."