Campaign Promises

Cabinet/Departments -> Health & Human Services


ItemHealth & Human Services
AbortionGrade
HE-1
The Promise: "...reproductive care is ... basic care, so it is at the center and at the heart of the plan that I propose...we're going to set up a public plan that all ... women can access if they don't have health insurance...including reproductive services..."
When/Where: Candidate Obama speech before the Planned Parenthood Action Fund, dated 07/17/07.
Source: http://lauraetch.googlepages.com/barackobamabeforeplannedparenthoodaction
Status:The Patient Protection and Affordable Care Act (ACA) (H.R. 3590) (Public Law 111-148) was signed into law by President Obama on 03/23/10. Section 1303, as amended by Section 10104, states in part that qualified health plans may elect whether or not to cover abortions and further includes "conscience language" that prohibits qualified health plans from discriminating against any health care provider because of unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Congressman Bart Stupak (D-MI) was co-sponsor of an amendment that would have prohibited the use of federal funds "to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion." Much to the chagrin of the Pro-Life segment of U.S. society, this language did not make it into the final version of the ACA. Congressman Stupak voted for it anyway.

Consequently, the ACA provides $317M for the Family Planning Program to serve 5.2M women and prevent 1M unintended pregnancies during FY2010 alone. Other funds in the ACA (about $11B) could be used to support abortions.

This promise was fulfilled.
1.00
AutismGrade
HE-2
The Promise: "...will fully fund the Combating Autism Act, which provides nearly $1 billion in autism-related funding over 5 years."
When/Where: Obama-Biden Plan: "Supporting Americans with Autism Spectrum Disorders (ASD)" dated 10/30/08.
Source: http://www.autismvotes.org/atf/cf/%7B2A179B73-96E2-44C3-8816-1B1C0BE5334B%7D/Obama%20campaign%20statement.pdf
Status:FY2010 budget appropriation for the Department of Health and Human Services (HHS) included $48M to the Health Resources and Services Administration (HRSA)/Autism and Other Developmental Disorders (a $6M increase over FY2009), $141M to the National Institutes of Health (NIH) and $22M for the Centers for Disease Control (CDC), all for activities associated with autism spectrum disorders (ASD), for a total of $211M against the authorized amount of $210M stipulated in "Combating Autism Act of 2006" (S. 843) (Public Law 109-416).

On top of the above, ASD research benefited from an additional $123.9M from tha American Recovery and Reinvestment Act (ARRA) of 2009.

For FY2011, President Obama's budget proposal included $222M across HHS activities for research, detection, treatment etc. related to improving the lives of individuals and families affected by ASD. The authorized amount for FY2011 was $231M as stipulated in the "Combating Autism Act of 2006."

On 09/30/11, President Obama signed into law the "Combating Autism Reauthorization Act (CARA) of 2011" (H.R. 2005) which authorized $924M in continued federal funding for FY2011-FY2014 ($231M per year) for autism research, treatment and services (source: "autismvotes.org"). This was followed by President Obama's signature of the FY2012 budget bill on 12/23/11 which authorized $230M for FY2012 CARA requirements.

The "Combating Autism Reauthorization Act of 2014," also known as the "Autism Collaboration, Accountability, Research, Education, and Support Act of 2014" (or "Autism CARES Act of 2014") (H.R. 4631) amended the Public Health Service Act to reauthorize research, surveillance, and education activities related to autism conducted by the Department of Health and Human Services (HHS). This bill was signed into law by President Obama on 08/08/14 and authorized $1.3B in funding for FY2015-2019 ($260M per year), an increase of $29M per year over the CARA of FY2011 authorization.

This promise was fulfilled.
1.00
HE-3
The Promise: "...will mandate insurance coverage of autism treatment and will also continue to work with parents, physicians, providers, researchers, and schools to create opportunities and effective solutions for people with ASD."
When/Where: Obama-Biden Plan: "Supporting Americans with Autism Spectrum Disorders (ASD)" dated 10/30/08.
Source: http://www.autismvotes.org/atf/cf/%7B2A179B73-96E2-44C3-8816-1B1C0BE5334B%7D/Obama%20campaign%20statement.pdf
Status:Although the Patient Protection and Affordable Care Act (ACA) of 2010 does not mention autism or Autism Spectrum Disorder (ASD) by name, insurance is mandated across the board for "behavioral health treatment", "developmental delays or disabilities", and other category descriptors under which ASD normally falls, to include the prohibition of pre-existing condition exclusions or discrimination based on health status (Section 2704).

In addition, funds are set aside in the Act for "mental and behavioral health education and training grants," "early identification and referral for children at risk for developmental or behavioral problems," screening activities for "mental health/behavioral health disorders," etc.

In 11/12, the Department of HHS advised states that if they did not have autism insurance reform laws in effect by 12/13, they could not have autism coverage for CY2014 and CY2015. As of CY2016, 44 states and the District of Columbia (DC) have autism insurance coverage.

The promise was to "mandate" that all states have insurance coverage for autism.

This promise was not fulfilled.
0.00
Cancer/Cancer ResearchGrade
HE-4
The Promise: "Will double federal funding for cancer research within 5 years."
When/Where: Obama-Biden Plan to Combat Cancer, 09/06/08.
Source: http://obama.3cdn.net/f8a8d6b8b4b370d888_24lmvygeu.pdf
Status:For FY2009, funding for cancer research was appropriated in the amount of $37.911B (the amount to "double"), broken down as follows:
- National Institutes of Health (NIH): $30.317B
- National Cancer Institute (NCI): $4.964B
- Food & Drug Administration (FDA): $2.040B
- Centers for Desease Control (CDC): $340M
- Department of Defense (DoD): $250M

The amount appropriated for FY2010 was NIH ($31.010), NCI ($5,103B), FDA ($2.362B), CDC ($475M) and DoD ($249M) for a total of $39.199B.

Under FY2011 Continuing Resolution, the appropriations were the same as for FY2010 except that DoD funding was eliminated, bring the total down to $38.950B.

FY2012 funding was in the following amounts: NIH ($35.000B), NCI ($5.740), FDA ($2.875), and CDC ($641M) for a total of $44.238B.

Although cancer research received small increases as reflected above, it was inconceivable that the $75.822B goal (double the FY2009 level) could be attained by FY2014.

This promise was not fulfilled.
0.00
HE-5
The Promise: "...will immediately direct his Secretary of Health and Human Services...to comprehensively examine the various cancer-related efforts of federal agencies, and provide recommendations to eliminate barriers to effective coordination across federal agencies and between the federal government and other stakeholders."
When/Where: The Obama-Biden Plan to Combat Cancer, dated 09/06/08.
Source: http://obama.3cdn.net/f8a8d6b8b4b370d888_24lmvygeu.pdf
Status:On 03/10/14, Health & Human Services (HHS) released its FY2014-FY2018 Strategic Plan to the public. The plan has the following goals:
Strategic Goal 1: Strengthen Health Care
Strategic Goal 2: Advance Scientific Knowledge and Innovation
Strategic Goal 3: Advance the Health, Safety, and Well-Being of the American People
Strategic Goal 4: Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs

Somewhere in this plan, the thrust of this promise could have been addressed.

As of end-CY2016, President Obama is not known to have taken the promised action, "immediately" or otherwise.

This promise was not fulfilled.
0.00
HE-6
The Promise: "Will provide the CDC $50 million in new funding to determine the most effective approaches that assist not only navigation of cancer patients through diagnosis and treatment processes, but also provide easy-to-understand information on the necessary follow-up steps to ensure continued lifelong health."
When/Where: The Obama-Biden Plan to Combat Cancer, dated 09/06/08.
Source: http://obama.3cdn.net/f8a8d6b8b4b370d888_24lmvygeu.pdf
Status:The Centers for Disease Control (CDC) FY2009 budget for cancer prevention and control was $340M.

During subsequent years, cancer prevention and control was funded as follows:

FY2010....$370M (+$30M)
FY2011....$325M (-$45M)
FY2012....$371M (+$46M)
FY2013....$337M (-$34M)
FY2014....$350M (+$13M)
FY2015....$352M (+$2M)
FY2016....$356M (+$4M)
FY2017....$302M (-$54M Requested)

Over President Obama's two terms in office, no "new funding" amounting to $50M was provided to the CDC for cancer prevention and control.

This promise was not fulfilled.
0.00
HE-7
The Promise: "...will seek to increase participation in clinical trials to 10 percent of adult cancer patients by requiring coverage of patient clinical trial costs in the new public and private plans offered through the National Health Insurance Exchange..."
When/Where: Obama-Biden Plan to Combat Cancer, 09/06/08.
Source: http://obama.3cdn.net/f8a8d6b8b4b370d888_24lmvygeu.pdf
Status:According to a Lancet Oncology Journal study published in 02/06, two of the main barriers to patient participation in clinical trials are (1) concern that joining a trial might reduce the patient's quality of life and (2) that the patient might receive a placebo instead of real medication to combat the cancer the patient is experiencing.

The National Cancer Institute estimated in 07/09 that less than 5% of adults diagnosed with cancer each year would participate in clinical trials.

A CY2016 report issued by the American Society of Clinical Oncology (ASCO) states the following: "...assembling and analyzing data from millions of electronic health records...will allow us to learn from every individual treated for cancer - not just the fewer than 5% of patients who currently participate in clinical trials."

This promise was not fulfilled.
0.00
ChildrenGrade
HE-8
The Promise: "Will provide affordable and high-quality child care that will promote child development and ease the burden on working families."
When/Where: Obama-Biden Plan: "Fighting Poverty and Creating a Bridge to the Middle Class" dated 09/11/08.
Source: http://www.africanamerica.org/fileSendAction/fcType/0/fcOid/128788938052174051/filePointer/128788938052442788/fodoid/128788938052442786/PovertyFactSheet.pdf
Status:The American Recovery and Reinvestment Act of 2009 pumped an additional $2B into the Child Care and Development Block Grant (CCDBG) coffers. With these funds, most states were able to sustain their child care assistance programs.

The Child Care and Development Block Grant Act of 2014 (S. 1086) was signed into law by President Obama on 11/19/2014. This law authorizes the following levels of funding for child care and development:

FY2015....$2.360B
FY2016....$2.478B
FY2017....$2.540B
FY2018....$2.603B
FY2019....$2.669B
FY2020....$2.749B

This promise was fulfilled.
1.00
HE-9
The Promise: "...will work with schools to create more healthful environments for children, including assistance with contract policy development for local vendors, grant support for school-based health screening programs and clinical services, increased financial support for physical education, and educational programs for students."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Fulfillment of this promise got off to a very slow start, with only $100K enacted to promote a "healthful environment" for children in FY2010. President Obama's FY2011 budget submission does a bit of catching up by proposing $6.3M to create healthier school environments for all children.

In light of Obama Administration objectives to reduce obesity in children, the first/critical step is the reauthorization of the Child Nutrition Act of 1966, which was extended to 09/30/10 under the Agriculture Appropriations Bill of 2009.

Senator Blanche Lincoln (D-AR) introduced the "Healthy, Hunger-Free Kids Act of 2010" (S. 3307) on 05/05/10. This bill passed the Senate on 08/05/10 and the House on 12/02/10. President Obama signed S. 3307 into law on 12/13/10.

S.3307 supported every aspect of this promise including vendor contracting policy, clinical services, child physical activity and education programs. This legislation remained in effect through FY2015.

On 04/20/16, Congressman Todd Rokita (R-IN) introduced the "Improving Child Nutrition and Education Act of 2016" (H.R. 5003). According to govtrack.us, this legislation had a 49% chance of being enacted before the 114th Congress expires at the end of CY2016.

On 07/06/16, Senator Pat Roberts (R-KS) introduced the "Improving Child Nutrition Integrity and Access Act of 2016" (S.3136). This bill had a 21% chance of enactment.

Either of the above bills, if signed into law before end-CY2016, would have satisfied the basic tenets of this promise.

Based on passage of S.3307 in CY2010, this promise was fulfilled.
1.00
HE-10
The Promise: "Part of Obama's early childhood intervention plan will be directed at coordinating fragmented community programs to help provide parents with information about screening for disabilities as infants and again as two-year olds."
When/Where: Obama-Biden Plan: "Empower Americans with Disabilities," dated 09/06/08.
Source: http://www.thearc.org/document.doc?id=3073
Status:Section 2951 of the Patient Protection and Affordable Health Care Act of 2010 stipulates in part that the purpose of the Maternal, Infant, and Early Childhood Home Visiting Programs amendment to Title V of the Social Security Act (42 U.S.C. 701 et seq.) is to "improve coordination of services for at risk communities."

The Act further specifies that within 6 months of its enactment, each State will conduct a statewide needs assessment. This research will address communitywide strategic planning and assessments conducted under the Head Start Act, as well as the "inventory of unmet needs and community-based and prevention-focused programs.

Under the Patient Protection and Affordable Health Care Act, this effort was authorized funding at the following levels:
FY2010....$100M
FY2011....$250M
FY2012....$350M
FY2013....$400M
FY2014....$450M.

This was a significant step toward "coordinating fragmented community programs" that should lead to the dissemination of information to parents about having their children screened for disabilities.

This promise was fulfilled.
1.00
HE-11
The Promise: "...would expand the highly-successful Nurse-Family Partnership to all low-income, first-time mothers. The Nurse-Family Partnership provides home visits by trained registered nurses to low-income expectant mothers and their families."
When/Where: Obama-Biden Plan "Fighting Poverty and Creating a Bridge to the Middle Class" dated 09/11/08.
Source: http://www.africanamerica.org/fileSendAction/fcType/0/fcOid/128788938052174051/filePointer/128788938052442788/fodoid/128788938052442786/PovertyFactSheet.pdf
Status:Section 2951 of the Patient Protection and Affordable Care Act, signed into law by President Obama on 03/23/10, provides "grants to eligible entities to enable the entities to deliver services under early childhood home visitation programs."

$1.5B was authorized by Congress for this purpose.

This promise was fulfilled.
1.00
Head StartGrade
HE-12
The Promise: "...increase Head Start funding..."
When/Where: Obama-Biden Plan: "Lifetime Success Through Education," dated 10/16/08.
Source: https://my.barackobama.com/page/-/HQpress/112007%20education%20plan%201.pdf
Status:The Head Start program (including Early Head Start) was funded at $6.878B in FY2008 and $9.213B in FY2009 (including $2.100B under the American Recovery and Reinvestment Act).

Department of Health and Human Services (HHS) budget authorizations in subsequent years were as follows:
FY2010....$7.234B
FY2011....$7.235B
FY2012....$7.969B
FY2013....$8.017B
FY2014....$8.597B
FY2015....$8.598B
FY2016....$9.168B
FY2017....$9.602B (Requested)

As of CY2016, these funds support 978K children, including over 100K in the Early Head Start program.

This promise was fulfilled.
1.00
HE-13
The Promise: "...will invest $10 billion per year in early intervention educational and developmental programs for children between zero and five. Their plan will help expand Early Head Start to serve more children with disabilities..."
When/Where: Obama-Biden Plan: "Empower Americans with Disabilities," dated 09/06/08.
Source: http://www.thearc.org/document.doc?id=3073
Status:More than $2.1 billion earmarked for these programs under the American Recovery and Reinvestment Act of 2009 increased participation in the Early Head Start Program from 90,400 in FY2009 to 154,000 by FY2014.

For FY2015 and FY2016, for example, a combination of Head Start (including Early Head Start) and Child Care and Development Block Grants has totaled $10.958B and $11.646B respectively.

This promise was fulfilled.
1.00
HE-14
The Promise: "The Obama-Biden comprehensive "Zero to Five" plan will provide critical support to young children and their parents...will create Early Learning Challenge Grants to promote state "zero to five" efforts and help states move toward voluntary, universal pre-school."
When/Where: Obama and Biden's Plan for America: "Blueprint for Change," dated 10/09/08.
Source: http://change.gov/agenda/education_agenda/
Status:The proposed Early Learning Challenge Fund would be administered as a collaborative effort between the Departments of Education and Health & Human Services. This fund challenged Governors to develop new model systems that (1) drive results-oriented, standards reform across programs, (2) fund and implement pathways to improve existing early learning programs, and (3) ensure that more children enter kindergarten ready.

On 5/25/11, the Secretaries of Education (Arne Duncan) and Health & Human Services (Kathleen Sibelius) announced that the Obama Administration will use $500M from the "Race to the Top" Program to fund an initial round of grants to states under what is now called the Race to the Top-Early Learning Challenge (RTT-ELC) Program. The period of effectivity for this program was 48 months from its inception.

This promise was fulfilled.
1.00
HE-15
The Promise: "Quadruple the number of eligible children for Early Head Start..."
When/Where: Obama-Biden Plan: "Lifetime Success Through Education," dated 10/16/08
Source: https://my.barackobama.com/page/-/HQpress/112007%20education%20plan%201.pdf
Status:In FY2009, the number of children under the age of three enrolled in Early Head Start was 90,400. For this promise to be fulfilled, 361,600 children would have to be enrolled in the Early Head Start program by end-CY2016. By FY2014, midway through President Obama's second term in office, the number had grown only to 154,000.

The promise to "quadruple" Early Head Start enrollment was not fulfilled.
0.00
Health Care System OverhaulGrade
HE-16
The Promise: "Invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009 (Pub.L. 111-5). Under the HITECH Act, the United States Department of Health and Human Services (HHS) reportedly spent $25.9B to promote and expand the adoption of health information technology.

Other sources reported that funding for health information technology reached $36.5B by CY2014 for standards-based Electronic Health Record/Electronic Medical Record (EHR/EMR) technology development. This amount could not be substantiated.

The budget authorization for the Office of the National Coordinator for Health Information Technology (ONC) is about $60M annually.

Given that the cumulative total of this promise amounts to $50B ($10B per year for five years) and notwithstanding the influx of HITECH/ARRA funds, it was inconceivable that the $50B goal could be achieved by FY2014.

This promise was not fulfilled.
0.00
HE-17
The Promise: "...implementing and funding evidence-based interventions, such as patient navigator programs"
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:The American Recovery and Reinvestment Act of 2009 includes $650 million "to carry out evidence-based clinical and community-based prevention and wellness strategies."

Implementation of the Patient Navigator Program is further codified in the Patient Protection and Affordable Care Act of 2010 (Section 3510), signed into law by President Obama on 03/30/10.

This promise was fulfilled.
1.00
HE-18
The Promise: "... will increase funding to expand community based preventive interventions to help Americans make better choices to improve their health."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:Announced by Mrs. Obama on 06/29/09, $851M has been allocated from the American Recovery and Reinvestment Act of 2009, signed into law 02/17/09, to expand community based preventive interventions.

This promise was fulfilled.
1.00
HE-19
The Promise: "...the government must invest in ...modernizing our physical structures, particularly our public health laboratories."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:The American Recovery and Reinvestment Act (ARRA) of 2009 (Economic Stimulus Bill) provided $1B "to construct, renovate or repair existing non-Federal research facilities."

This promise was fulfilled.
1.00
HE-20
The Promise: "Through the Exchange, any American will have the opportunity to enroll in the new public plan..."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:This promise refers to the establishment of a "public option". The Patient Protection and Affordable Care Act (Public Law 111-148) signed into law by President Obama on 03/23/10, does not include a "public option".

This promise was not fulfilled.
0.00
HE-21
The Promise: "Large employers that do not offer meaningful coverage or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Section 1304 of the Patient Protection and Affordable Care Act (Public Law 111-148), signed into law by President Obama on 03/23/10, defines "large employer" as one that "employed an average of at least 101 employees on business days during the preceding calendar year and employs at least 1 employee on the first day of the plan year."

Section 1513 of the above Act supports promise fulfillment by stating: "Large Employers Not Offering Health Coverage....then there is hereby imposed on the employer an assessable payment equal to the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees...". This part of the promise was fulfilled.

The Patient Protection and Affordable Care Act also provides states with the option of considering businesses with 50 to 100 employees as small employers.

Effective in CY2015, the penalty for small businesses not covering their workers is $2K per employee (minus the first 30 full-time employees) if an employer does not offer coverage. For employers who do provide coverage but that coverage does not provide minimum value or is not affordable, the fee is the lesser of $3K per full-time employee receiving subsidy, or $2K per full-time employee (minus the first 30).

Small businesses are not required to contribute a percentage of their payroll toward the costs of the national plan as a penalty for not offering "meaningful" coverage.

This promise was fulfilled.
1.00
HE-22
The Promise: "...will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:Under the American Recovery and Reinvestment Act (ARRA) of 2009, $250M was made available to 17 "beacon communities" for clinicians, hospitals and consumers to work together to implement "health IT."

In addition to funds made available to the Office of the National Coordinator for Health Information Technology, nearly $29M has been made available on an annual basis to the Agency for Health Care Research and Quality (AHRQ) to advanced the use of "health IT" and to the Office of Civil Rights to strengthen and enforce "health IT" privacy rules.

President Obama's FY2011 budget proposal included $110M for continuing efforts to "strengthen health IT policy, coordination and research activities." This, when coupled with FY2010 budget and ARRA appropriations, is indicative that President Obama has been serious about keeping this promise.

This promise was fulfilled.
1.00
HE-23
The Promise: "Require that plans that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize disease management programs to improve efficiency and lower costs."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Multiple sections of the Patient Protection and Affordable Care Act (Public Law 111-148), signed into law by President Obama on 03/23/10, address "disease management" initiatives and incentives either directly or under the umbrella of a Patient-Centered Medical Homes (PCMH) program. However, nowhere in this Act does it specifically levy a requirement that plans utilize disease management programs to improve efficiency and lower costs, except that the participation in such programs will be directly tied to a health care provider's reimbursement structure starting in CY2012.

The Health Care and Education Act of 2010 (H.R. 4872) signed into law by President Obama on 03/30/10 makes no mention of disease management program participation.

To keep the background of this promise in perspective, in CY2004, a Congressional Budget Office (CBO) study revealed that there was "insufficient evidence to conclude that disease management programs can generally reduce overall health spending."

Further, the Centers for Medicare & Medicaid Services (CMS) awarded grants in CY2005 to see whether disease management programs would cut Medicare costs and improve quality of care. CMS shut this program down in CY2008 because three of the eight grantees dropped out of the study citing cost overruns, and the remaining five could not substantiate cost reductions in terms of fewer hospitalizations or emergency room visits by the approximately 150,000 Medicare recipients studied.

A CY2009 CBO report further states that there is "no conclusive evidence that [disease management] reduces everall costs and only limited evidence that it can improve quality care for some conditions." However the FEHBP, in which approximately 250 local and national plans participate to serve about 8M enrollees, has a robust disease management program targeted to care for members with chronic or life-threatening diseases in the areas of asthma, diabetes, cardiovascular disease, and cancer.

This promise was not fulfilled.
0.00
HE-24
The Promise: "...will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care and costs."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:The Patient Protection and Affordable Care Act of 2010 signed into law by President Obama on 03/30/10, contains provisions for the reporting of medical errors. On nurse staffing ratios, however, reporting requirements are limited to nurse staffing levels for "skilled nursing facilities and nursing facilities" (Sections 6103 and 6112).

Reporting on hospital-acquired infections is mandated by Section 10303 of the above Act.

Reporting requirements for disparities in health care provision and related costs are also addressed extensively in the above Act, notably in Sections 4201 and 4302.

This promise was fulfilled.
1.00
HE-25
The Promise: "...will also challenge the medical system to eliminate inequities in health care by requiring hospitals and health plans to collect, analyze and report health care quality for disparity populations and holding them accountable for any differences found..."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:The Patient Protection and Affordable Care Act (ACA) of 2009, signed into law by President Obama on 03/30/10, includes "programs that address, identify, and ameliorate health care disparities among principal at-risk subpopulations." Specifically,

- Section 4201 (Community Transformation Grants) makes funds available for entities for "prioritizing strategies to reduce racial and ethnic disparities, including social, economic, and geographic determinants of health."

- Section 4302 of this Act (Understanding Health Disparities Data Collection and Analysis) mandates that by 03/30/12, "any federally conducted or supported health care or public health program, activity or survey...collects and reports...any other demographic data as deemed appropriate by the Secretary [of Health and Human Services] regarding health disparities."

Lacking in the ACA of 2009 was the requirement for hospitals and health care plans to report on the quality of health care provided to disparity populations.

In the interim, the "HHS Action Plan to Reduce Racial and Ethnic Health Disparities" of 04/11 acknowledges its limited ability "to identify disparities and effectively monitor efforts to reduce them by a lack of specificity, uniformity, and quality in data collection and reporting procedures" and outlines the steps the HHS will take to address this situation, to include steps it will take to ensure accountability.

Also in 04/11, the Obama Administration released its "National Stakeholder Strategy for Achieving Health Equity" which further reflects a reporting and accountability commitment.

The most recent version of a "Health Equity and Accountability Act (HEAA)" to codify reporting requirements excluded from the ACA of 2009, H.R. 5475 introduced by Congresswoman Robin Kelly (D-IL) on 06/14/16, has no chance of being signed into law before end-CY2016.

Nonetheless, this promise was fulfilled.
1.00
HE-26
The Promise: "Reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Section 1102 of the Patient Protection and Affordable Care Act (Public Law 111-148), signed into law by President Obama on 03/23/10, comes closest to addressing the intent of this promise. This section states that "...the Secretary [of Health and Human Services] shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that...shall not be less than $15,000 nor greater than $90,000..." and "shall be used to lower costs of the plan....Such payments shall not be used as general revenues for an entity...".

Unfortunately, the reimbursements under this Act do not directly relate to "catastrophic costs they [employer health plans] incur above a threshold." Such costs typically exceed $90,000.

This promise was not fulfilled.
0.00
HE-27
The Promise: "...will expand funding, including loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve working conditions to ensure a strong workforce that will champion prevention and public health activities."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:The American Recovery and Reinvestment Act (ARRA) of 2009 provided $1.5B to the Department of Health and Human Services (HHS) for "grants for construction, renovation and equipment...for health centers" and $300M for the National Health Service Corps (NHSC) "to address professions shortages...to provide scholarships, loan repayment, and grants to training programs...". Of this amount, $240M was for the recruitment of clinicians to serve in health professional shortage areas and the balance is for field operations.

The Patient Protection and Affordable Care Act of 2010 goes even further. The levels of funding authorized for the NHSC under this Act are as follows: FY2010-$320M, FY2011-$414M, FY2012-$535M, FY2013-$691M, FY2014-$893M,and FY2015-$1.1B. For FY2016 and each fiscal year thereafter, the amount appropriated is to be the preceding year's authorization plus adjustments.

Starting from a workforce baseline of 3,600 NHSC health care providers in CY2008, the number nearly tripled to about 9,600 by end-CY2015.

This promise was fulfilled.
1.00
HE-28
The Promise: "...will build on America's unparalleled talent and advantage in science, technology, and engineering, and the powerful insights into biological systems that are emerging, to create new drugs, vaccines, and diagnostic tests and to manufacture these vital products much more quickly and efficiently than is now possible."
When/Where: Obama-Biden Plan: "Strengthening Homeland Security" dated 10/17/08.
Source: http://change.gov/agenda/homeland_security_agenda/
Status:Under the American Recovery and Reinvestment Act (ARRA) of 2009, $100B was dedicated to developing science and technology capabilities and, by extension, provided funding for about 12K research projects with $750M going toward advanced heart, lung and blood disease research.

This promise was fulfilled.
1.00
HE-29
The Promise: "...will attract more doctors to rural areas."
When/Where: Obama and Biden's Plan for America: "Blueprint for Change," dated 10/09/08.
Source: http://change.gov/agenda/poverty_agenda/
Status:Section 5606, Subpart II of the Patient Protection and Affordable Health Care Act of 2010 included $4M in grants per year from FY2010 through FY2013 to attract medical students to complete their residencies in rural/underserved communities or at "local residency training programs that support and train physicians to practice in underserved rural communities."

This promise to "attract" more doctors to rural areas was fulfilled.
1.00
HE-30
The Promise: "...will also work to ensure that environmental health issues in the wake of man-made or terrorist disasters are promptly addressed by federal, state and local officials."
When/Where: Obama-Biden Plan: Promoting a Healthy Environment" dated 10/08/08.
Source: http://www.environbusiness.com/uploads/pdf/obamaenvironmentalplan.pdf
Status:The Patient Protection and Affordable Care Act of 2010 would have been an excellent opportunity to codify this promise. Instead, the only environmental health conditions addressed therein (Section 10323) are related to "asbestosis, pleural thickening, or pleural plaques...mesothelioma...and any other medical condition which the Secretary determines is caused by exposure to a hazardous substance or pollutant or contaminent at a Superfund site..." No mention is made of environmental health issues as a result of man-made or terrorist disasters.

However, as of CY2016, in conjuction with the Federal Emergency Management Agency (FEMA), the Centers for Disease Control (CDC) has developed an Environmental Health Training in Emergency Response (EHTER) program. This new training program instructs participants on how to identify problems, hazards, and risks; plan for team response; select appropriate equipment and instrumentation; perform required tasks using environmental health response protocols; and report and participate in follow-up activities as instructed. Most of the course involves hands-on operation practice and response to simulated events.

This promise was fulfilled.
1.00
Health InsuranceGrade
HE-31
The Promise: "Create a "National Health Insurance Exchange to help Americans and businesses purchase private health insurance."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:On 07/14/09, the House tabled its version of America's Affordable Health Choices Act (AAHCA) of 2009. Title III, Section 301 of the bill presented by the House proposed to create a National Insurance Exchange under a Health Choices Administration, with a Commissioner to run it.

Section 1311 of the Senate version of the health care reform bill stated in part "Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange."

The final language included in the Patient Protection and Affordable Care Act (Public Law 111-148), signed into law by President Obama on 03/23/10, supports the Senate version of the Health Care Reform effort in that the exchange is to be established at the State level, not the National level.

This promise was not fulfilled.
0.00
HE-32
The Promise: "Require insurance companies to cover pre-existing conditions...at fair and stable premiums."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Section 2704 of the Patient Protection and Affordable Care Act (Public Law 111-148) signed into law by President Obama on 03/23/10, is entitled "Prohibition of Preexisting Condition Exclusions or Other Discrimination Based on Health Status." This is self-explanatory.

This promise was fulfilled.
1.00
HE-33
The Promise: "If you don't have insurance, or don't like your insurance, you'll be able to choose from the same type of quality private plans as every federal employee...All of these plans will cover essential medical services including prevention, maternity, disease management and mental health care. No one will be turned away because of a pre-existing condition. If you change jobs, this insurance will go with you. And if you can't afford this insurance, you'll receive a tax credit to help pay for it."
When/Where: Obama Campaign Speech, Asheville, NC dated 10/05/08.
Source: http://www.presidency.ucsb.edu/ws/index.php?pid=84480
Status:Section 1312 of the Patient Protection and Affordable Case Act (ACA) of 2010, signed into law on 03/30/10, stipulates that "the only health plans that the Federal Government may make available to Members of Congress and congressional staff...shall be health plans that are created under this Act...or offered through an Exchange established under this Act...".

Promised medical services are included in this Act such as prevention (Title IV), maternity (Section 10213), and disease management and mental health care (both under Section 1302). Health plan tax credits for low-income individuals are addressed in Section 1331(e) of the Act.

As of CY2016, tax credits payable to insurers under the ACA are based on income and available to American taxpayers making between 100% and 400% of the Federal Poverty Level (between $11,770-$47,080 for an individual and between $24,250-$97,000 for a family of four).

On 11/14/11, the Supreme Court agreed to hear the legal challenges to the ACA filed by 26 states and the National Federation of Independent Business. On 06/28/12, the Supreme Court upheld the Patient Protection and ACA of 2010 as constitutional. The majority ruled that the "individual mandate" for most U.S. citizens to obtain insurance or pay a penalty was authorized by Congressional power to levy taxes. The Supreme Court again upheld the ACA on 06/25/15.

This promise was fulfilled.
1.00
HE-34
The Promise: "...will expand the number of options for young adults to get coverage by allowing young people up to age 25 to continue coverage through their parents' plans."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Under the Patient Protection and Affordable Care Act (Public Law 111-148) signed into law by President Obama on 03/23/10, children will be able to get health insurance coverage under their parents' insurance plans as long as they do not have the possibility of acquiring coverage through their own employers and have not yet turned 26 -- one year longer than originally proposed by then-candidate Obama.

This promise was fulfilled.
1.00
HE-35
The Promise: "I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year."
When/Where: Obama Campaign Speech, Hartford, CT, dated 06/23/07.
Source: http://www.presidency.ucsb.edu/ws/index.php?pid=76986
Status:President Obama signed the Patient Protection and Affordable Care Act (ACA) of 2010 on 03/23/10.

In CY2009, when President Obama became President, premiums for a "typical" family where the principal earner worked for a small business (3 to 199 employees) was about $12,696. This rose to $17,546 by CY2016. Premiums for workers in large companies (200 or more employees) rose from $13,704 in CY2009 to $18,142 in CY2016.

On 10/03/16, former President Bill Clinton provided his views on ACA, also referred to as "Obamacare:" "So you've got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It's the craziest thing in the world."

This promise did not address the cost of premiums after tax credits, etc., simply the cost of premiums. As more insurance providers withdraw from ACA exchange participation such as Aetna, Humana and UnitedHealth Group, premium costs are expected to skyrocket during CY2017 with the national average increase by about 25%. Such increases will vary by state but in Phoenix, AZ alone, individual benchmark insurance premiums in the ACA marketplace are expected to increase by a whopping 145%. In Birmingham, AL, that increase is estimated to be 71% in CY2017.

One of the root problems of this evolving situation is that the number of older, sicker enrollees outpaces the number of younger, healthier people signing up for health insurance, preferring to pay an annual fine over more expensive coverage. Another problem is that instead of the 20M insurance purchasers estimated by the Office of Management and Budget (OMB) by end-CY2016 to make ACA work, only between 11M and 13.8M people have signed up.

This promise was not fulfilled.
0.00
HE-36
The Promise: "Health plans will be required to disclose the percentage of premiums that actually goes to paying for patient care as opposed to administrative costs."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:Section 2718 of the Patient Protection and Affordable Case Act of 2010, signed into law by President Obama on 03/30/10, stipulates that "A health insurance issuer offering group or individual health insurance coverage shall, with respect to each plan year, submit to the Secretary a report concerning the percentage of total premium revenue that such coverage expends (1) on reimbursement for clinical services provided to enrollees under such coverage; (2) for activities that improve health care quality; and (3) on all other non-claims costs, including an explanation of the nature of such costs, and excluding State taxes and licensing or regulatory fees."

This promise was fulfilled.
1.00
HE-37
The Promise: "In markets where the insurance business is not competitive, their plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Section 2718 of the Patient Protection and Affordable Care Act of 2010, entitled "Bringing Down the Cost of Health Care Coverage," states in part: "a State shall seek to ensure adequate participation by health insurance issuers, competition in the health insurance market in the State, and value for consumers so that premiums are used for clinical services and quality improvements."

Section 2718 also requires insurance providers to rebate part of the premiums it received if 85% of those premiums were not spent on doctor or hospital bills or activities to improve health care quality. For CY2011, for example, the UnitedHealthcare insurance company met only 84% of the established expenditure criteria and had to issue rebates equivalent to 1% of its earned premium dollars to employers or group policyholders by 08/01/12.

This promise was fulfilled.
1.00
HE-38
The Promise: "Under the plan, if you like your current health insurance, nothing changes..."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:Commencing in CY2011, $132B in federal subsidies to support Medicare Advantage (MA) plans started to be phased out. With the gradual elimination of these subsidies, coverage for expenditures such as for dental care, hearing aids and eyeglasses were reduced or eliminated. Costs of premiums for these services increased as seniors tried to find similar coverage elsewhere.

So for seniors who liked their health insurance coverage under MA through CY2010, their plan started to change in CY2011. In testimony before Congress on 01/26/11, Medicare Actuary Richard Foster supported this view by stating that he expected 7M MA participants to be forced to purchase supplementary health insurance over time because of the Government's curtailment of support to the MA plans they liked and therefore selected prior to CY2010.

Despite contradictory analyses, it is safe to consider, based on media reports, that between 2.6M and 4.7M health insurance policies were cancelled between CY2010 and CY2014 regardless of whether a policyholder was happy with his/her plan. In most cases, the cancelled plans did not meet the coverage standards mandated by the ACA. Insurers that did not leave the individual health insurance market altogether offered their policyholders alternative plans, often plan the policyholder did not like.

Since the implementation of the Patient Protection and Affordable Care Act (ACA) on 10/01/13, not only have insurance premium rates continued to rise, but millions of health insurance policies that policyholders liked have been cancelled.

It should be noted that there was no guarantee in the ACA that policyholders would get to keep their health insurance policies just because they liked those policies.

This promise was not fulfilled.
0.00
MedicaidGrade
HE-39
The Promise: "Expand eligibility for the Medicaid and SCHIP [State Children's Health Insurance Fund] programs and ensure that these programs continue to serve their critical safety net function."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:President Obama signed the SCHIP portion of this promise into law on 02/04/09. The promise also included a MEDICAID eligibility expansion promise which was kept by inclusion of $87B in the American Recovery and Reinvestment Act (ARRA) of 2009 of 02/17/09.

Under the Patient Protection and Affordable Care Act (Public Law 111-148) signed into law by President Obama on 03/23/10, MEDICAID was further expanded starting in CY2014 for individuals "who are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under Part A of Title XVIII, or enrolled for benefits under Part B of Title XVIII....and whose income...does not exceed 133 percent of the poverty line...".

In CY2011, however, additional MEDICAID assistance provided by the government to states ran out. Consequently, more than half of the states reduced payments to health providers, 23 lowered spending on prescription drugs, and 20 restricted coverage of other services.

Nonetheless, expanding eligibility for MEDICAID became a reality when the Patient Protection and Affordable Care Act was fully implemented starting in CY2014.

This promise was fulfilled.
1.00
Medical InfrastructureGrade
HE-40
The Promise: "...will rebuild broken facilities and provide incentives, such as loan forgiveness, to lure medical professionals back to the region."
When/Where: Obama-Biden Plan: "Rebuilding the Gulf Coast and Preventing Future Catastrophes", dated 09/11/08.
Source: https://my.barackobama.com/page/-/HQpress/020708%20Katrina%20Fact%20Sheet.pdf
Status:On 08/29/05 when Hurricane Katrina hit New Orleans, the city's health care infrastructure was devastated with its inpatient bed capacity reduced from 4,080 in the parishes of Orleans, Jefferson, Plaquemine and St. Bernard to 664.

During President Obama's tenure in office, work continued to improve the availability of medical facilities in New Orleans. Examples: (1) New Orleans East Hospital, 80 beds, opened 08/14; (2) University Medical Center, 446 beds, opened 08/15; (3) VA Hospital Complex, 120 beds, to open in CY2017.

The number of ambulatory care clinics in the New Orleans area was reduced from 90 to about 19 by Hurricane Katrina. As of CY2016, there are about 195 fully functional care centers and clinics in/around New Orleans.

An estimated 4,500 physicians were dislocated, approximately 35% of them being primary care doctors. The Department of Health and Human Services (HHS) stepped in with a $100M Primary Care and Stabilization Grant (PCASG) to support neighborhood primary and behavioral health care system, administered by the Louisiana Public Health Institute (LPHI).

The College Cost Reduction Act, signed into law by President Obama in 07/09, allowed students to pay off loans backed by federal guarantees at rates tied to their income, and have those loans forgiven after 10 years of public service in all levels of government and 501(c)3 or nonprofit organizations. This program served as a means to provide loan forgiveness for some physicians to return to New Orleans.

This promise was fulfilled.
1.00
HE-41
The Promise: "...will fight to establish a major medical complex in downtown New Orleans that will serve the entire community."
When/Where: Obama-Biden Plan: "Rebuilding the Gulf Coast and Preventing Future Catastrophes", dated 09/11/08.
Source: https://my.barackobama.com/page/-/HQpress/020708%20Katrina%20Fact%20Sheet.pdf
Status:Ground was broken on 04/18/11 for a new $1.2B University Medical Center (UMC) to be built in New Orleans. The facility opened for business on 08/01/15.

Strategically located to permit the sharing of facilities and services with the fure New Orleans VA Medical Center (to open in CY2017), the new UMC will occupies 37 acres in the Biosciences District and acts as a Level 1 trauma center to provide critical care for the area's most severely injured patients. The bed count for this new facility is 446.

To avoid a repeat of the destruction caused by Hurricane Katrina, the UMC was constructed more than 20 feet above sea level and can withstand a Category 3 hurricane.

This promise was fulfilled.
1.00
MedicareGrade
HE-42
The Promise: "...eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:The Department of Health and Human Services budget for 2010 provided $311M for greater program integrity oversight for the Medicare program, including Medicare Advantage (Part C) against fraud, waste and abuse. According to a Government Accountability Office (GAO) analyses, Part C cost the American taxpayer $48B in fraudulent Medicare claims in CY2010 alone.

Under the Health Care and Education Reconciliation Act of 2010 signed into law by President Obama on 03/30/10, government subsidies to Medicare Advantage, the private-health plan alternative to traditional Medicare, were cut back steeply. Prior to this Act, the government paid the private plans an average of 14% more than traditional Medicare.

The new bill, besides reducing payments overall, shifted the funding -- some high-cost areas would be paid 5% less than traditional Medicare, while some lower cost areas would be paid up to 15% more. This was a positive step toward eliminating "excessive subsidies."

This promise was fulfilled.
1.00
HE-43
The Promise: "...close the 'doughnut hole' in the Medicare Part D Prescription Drug Program that limits benefits for seniors with more than $2,250 but less than $5,100 in annual drug costs."
When/Where: Obama Plan: "Helping America's Seniors" dated 10/26/07.
Source: http://obama.3cdn.net/9f74cf3238357d0e28_olgimv8il.pdf
Status:The CY2010 numbers were actually more than $2,800 but less than $4,550. In application, after a $310 deductible, drug costs were reimbursed at 75% when they were less than $2,800 annually, and Medicare covered 95% of the cost of drugs once their accumulated cost rose above $4.550 annually. Between these two numbers ($1,750 - called the "donut hole" or gap), there was no reimbursement.

Under the Patient Protection and Affordable Care Act (ACA) (Public Law 111-148) signed into law by President Obama on 03/23/10, any Medicare Part D beneficiary who crossed into the donut hole in CY2010 received a $250 check to help defray their prescription drug costs.

By CY2016, the coverage gap (donut hole) began once a beneficiary's Medicare Part D plan's initial coverage limit ($3,310) and ended when the beneficiary spent a total of $4,850, a gap of $1,540. Enrollees received a 55% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer applied to getting out of the donut hole, however the additional 5% paid by Medicare Part D plan did not count toward an enrollee's True Out-of-Pocket (TrOOP) expenses. Enrollees also paid a maximum of 58% co-pay on generic drugs purchased while in the coverage gap (a 42% discount).

Dependent upon the coverage plan selected, Part D premiums range from $10 to $100 per month. The maximum deductible for Part D in CY2016 was $360.

President Obama promised to "close" the donut hole. This didn't happen during his two terms in office. The best he could do was to lay the groundwork in the ACA for the donut hole to be closed by CY2020.

This promise was fulfilled.
1.00
HE-44
The Promise: "...will ensure seniors are provided with information about the best prescription drug plans for them every year....will require companies to send Medicare Part D beneficiaries a complete list of the drugs the individual used the past year as well as the pertinent fees paid the previous year. Companies will also be required to provide seniors with online versions of this information, so that they can use it at a third-party comparison shopping site, similar to Priceline.com."
When/Where: Obama Plan: "Helping America's Seniors" dated 10/26/07.
Source: http://obama.3cdn.net/9f74cf3238357d0e28_olgimv8il.pdf
Status:The Patient Protection and Affordable Care Act (H.R. 3590) signed into law on 03/23/10 includes Section 3021 entitled "Health Information Technology Enrollment Standards and Protocols" that will provide a "Capability for individuals to apply, recertify and manage their eligibility information online, including at home, at points of service, and other community-based locations." This is the closest reference toward a simplified, automated process for individual health care subscibers, but does not specifically pertain to the promise for companies to provide drug use information to Medicare Part D participants.

While the Center for Medicare and Medicaid Services (CMS) provides access to information related to prescribed drugs and medications to beneficiaries through its MyMedicare.gov website, there is no provision for provider companies to supply this information to enrollees.

This promise was not fulfilled.
0.00
HE-45
The Promise: "Allow Medicare to negotiate for cheaper drug prices...repeal the ban on direct negotiation with drug companies..."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:Widely reported backroom deals between President Obama and the Pharmaceutical Research and Manufacturers of America (PhRMA) on 08/04/09 resulted in an agreement for the brand name drug manufacturers to pay new fees and, with effect in CY2011, provide a 50% discount on Medicare Part D prescriptions.

The Patient Protection and Affordable Care Act of 2009 makes numerous references to "negotiated" drug prices, but falls short of specifying the negotiating parties when it comes to Medicare Part D.

On 01/06/15, Senator Amy Klobuchar (D-MN) introduced the "Medicare Prescription Drug Price Negotiation Act of 2015" (S. 31). On 09/15/15, Congressman Elijah Cummings introduced the "Prescription Drug Affordability Act of 2015" (H.R. 3513). Either of these bills would have enabled the Department of Health and Human Services (HHS) to negotiate cheaper drugs with pharmaceutical companies. Neither of these bills were given a chance of being signed into law by govtrack.us before the 114th Congress expires at the end of CY2016.

This promise was not fulfilled.
0.00
HE-46
The Promise: "Amend the Medicare 'homebound' rule, which requires severely disabled recipients to stay in their homes to retain benefits, so that they have the freedom to leave their homes without fear of having their home-health benefits taken away."
When/Where: Obama-Biden Plan: "Empower Americans with Disabilities," dated 09/06/08.
Source: http://www.thearc.org/document.doc?id=3073
Status:Section 30.1.1 of the Centers for Medicare and Medicaid Services (CMS) Medicare Benefit Policy Manual (Revision 208 effective 01/01/15) defines the homebound policy as "Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited to furnish adult day-care services in a State, shall not disqualify an individual from being considered to be confined to his home. Any other absence of an individual from the home shall not so disqualify an individual if the absence is of an infrequent or of relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration. It is expected that in most instances, absences from the home that occur will be for the purpose of receiving health care treatment. However, occasional absences from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home."

Thus a Medicare beneficiary may leave his/her home on an "infrequent or short duration" basis without fear of having their home-health benefits taken away.

This promise was fulfilled.
1.00
PharmaceuticalsGrade
HE-47
The Promise: "Prevent drug companies from blocking generic drugs from consumers...will work to ensure that market power does not lead to higher prices for consumers.."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:For decades, some brand-name drug manufacturers have resorted to "product switching" or "product hopping" tactics designed to delay or prevent entirely the entry of generic drugs into the market, thereby protecting their market shares.

Reportedly, brand name drug manufacturers have benefited from price fixing deals (reverse payment agreements to protect patent holders) with generic drug manufacturers to delay the entry of generic drugs on the market, as authorized under the Drug Price Competition and Patent Term Restoration Act of 1984.

The Patient Protection and Affordable Care Act (ACA) of 2009 included a provision mandating that the Secretary of Health and Human Services shall "facilitate generic substitution when a generic covered outpatient drug is available at a lower price" but fell far short of preventing brand name drug manufacturers from blocking generic drug manufacturers. In fact, the Section 7002 of the ACA protects the brand name drug manufacturers by stipulating that applications for generic (biosimilar) drugs "may not be made effective by the Secretary until the date that is 12 years after the date on which the reference product was first licensed...".

President Obama's FY2010 budget proposal included language "prohibiting anticompetitive agreements and collusion between brand name and generic drug manufacturers intended to keep generic drugs off the market" and prohibiting drug manufacturers from "reformulating existing products into new products."

Several bills to codify the objective of this promise were introduced in Congress since CY2009. The most recent: on 09/22/15, Senator Amy Klobuchar (D-MN) introduced a new iteration of the "Preserve Access to Affordable Generics Act" (S.2019) which has as its purpose: "(1) to enhance competition in the pharmaceutical market by stopping anticompetitive agreements between brand name and generic drug manufacturers that limit, delay, or otherwise prevent competition from generic drugs; and (2) to support the purpose and intent of antitrust law by prohibiting anticompetitive practices in the pharmaceutical industry that harm consumers."

According to govtrack.us, the above bill has little to no chance of being enacted before the 114th Congress expires at the end of CY2016.

This promise was not fulfilled.
0.00
HE-48
The Promise: "... will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S."
When/Where: Obama-Biden Plan: "To Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All," dated 10/03/08.
Source: http://mendocinohre.org/rhic/200812/HealthCareFullPlan.pdf
Status:In return for pledges by the pharmaceutical companies to put up $80 billion over 10 years in pledged cost reductions, it appeared that the White House had assented to move away from ideas like the government negotiation of drug prices or permitting the importation of cheaper drugs from developed countries such as Canada.

On 12/20/09, however, White House aide David Axelrod reaffirmed President Obama's commitment to allow the re-importation of drugs initially produced in the U.S., exported, then imported back into the country at a lower cost than the same drug costs in the U.S.

Neither the Patient Protection and Affordable Care Act of 2010 nor the Health Care and Education Reconciliation Act of 2010 mentions any authorization to reimport drugs from such origins as Canada.

In CY2000, the Medicine Equity and Drug Safety Act (MEDSA) was signed into law by President Clinton to permit the importation of safe and cost effective pharmaceuticals into the USA. As of early-CY2013, the provisions of the above law have not been implemented by the Secretaries of Health & Human Services of the President Clinton, Bush or Obama administrations.

This promise has not been fulfilled.
0.00
PregnancyGrade
HE-49
The Promise: "...will work to reduce unintended pregnancy by guaranteeing equity in contraceptive coverage, providing sex education and offering rape victims accurate information about emergency contraception."
When/Where: Obama and Biden's Plan for America: "Blueprint for Change," dated 10/09/08.
Source: https://www.documentcloud.org/documents/550007-barack-obama-2008-blueprint-for-change.html
Status:The "Safe Motherhood/Infant Health" line item in the FY2010 appropriation for the Department of Health and Human Services (HHS) includes $15.8M to provide "medically accurate and age appropriate" information on contraception to youth. This was an increase of $5M over FY2009 funding.

The Patient Protection and Affordable Care Act of 2010 authorized an additional $10M for grants "to implement innovative youth pregnancy prevention strategies and target services to high-risk, vulnerable, and culturally under-represented youth populations...".

In 10/10, the Obama Administration announced a $110M campaign to support a range of unintended pregancy prevention initiatives to include sex education and the benefits of contraception, as well as focusing on encouraging teens to delay sex.

This promise was fulfilled.
1.00
ResearchGrade
HE-50
The Promise: "As President, I will lift the current administration's ban on federal funding of research on embryonic stem cell lines created after August 9, 2001 through executive order."
When/Where: Science Debate 2008, Obama Response to Top Science Questions, 08/30/08.
Source: http://www.sciencedebate.org/2012/debate08.html
Status:Embryonic Stem Cells (ESC) are cells that can morph into any cell of the body. Potentially, they could someday cure such ailments as spinal cord injuries, quadriplegia, diabetes, and Parkinson's Disease.

President Obama signed Executive Order 13505 on 03/09/09 entitled "Removing Barriers to Responsible Scientific Research Involving Human Stem Cells". This Executive Order revoked the Presidential Statement of 08/09/01 limiting federal funding for embryonic stem cell research as well as its supplementing Executive Order 13435 dated 06/20/07.

According to Executive Order 13505, the Secretary of Health and Human Services (HHS), through the Director of National Institutes of Health (NIH), "may support and conduct responsible, scientifically worthy human stem cell research, including human embryonic stem cell research, to the extent permitted by law." The NIH authorized the first 13 lines of cells on 12/02/09, with another 20 in the works.

This promise was fulfilled.
1.00
HE-51
The Promise: "I will ensure that all research on stem cells is conducted ethically and with rigorous oversight."
When/Where: Science Debate 2008, Obama Response to Top Science Questions, 08/30/08.
Source: http://www.sciencedebate.org/2012/debate08.html
Status:The executive order lifting restrictions on stem cell research that was signed on 03/09/09 by President Obama also directed the Secretary of Health and Human Services to issue new guidelines for the research within 120 days (by mid-07/09).

According to President Obama's Executive Order, these guidelines were to include "provisions establishing appropriate safeguards," and should be updated "periodically..."

On 04/23/09, the National Institutes of Health (NIH) published draft stem cell guidelines for public comment. By 05/26/09, nearly 50,000 comments on the draft guidelines were received and NIH published them on its web site. The final guidelines were published with an effective date of 07/07/09.

Although the U.S. District Court of Washington, D.C. ruled on 08/23/10 that federal funding cannot be used for Embryonic Stem Cell (ESC) research under the Dickey-Wicker Amendment (P.L. 104-99) of CY1996 until that law is changed by Congress, the above guidelines also apply to privately funded ESC research efforts against which there is no current prohibition.

This promise was fulfilled.
1.00
HE-52
The Promise: "...will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have accurate and objective information to make the best decisions for their health and well-being."
When/Where: Obama-Biden Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage For All, dated 10/03/08.
Source: http://courses.ischool.berkeley.edu/i202/f08/lectures/Obama_Healthcare-1.pdf
Status:The American Recovery and Reinvestment Act of 2009 signed into law by President Obama on 02/17/09 started promise fulfillment by investing $700M for "comparative effectiveness research".

Under the Patient Protection and Affordable Care Act (Public Law 111-148) signed into law by President Obama on 03/23/10, a new Patient-Centered Outcomes Research Institute was created to fund comparisons of medical treatments.

This promise was fulfilled.
1.00
HE-53
The Promise: "By making steady increases that double NIH's [National Institutes of Health] budget over ten years..."
When/Where: Obama-Biden Plan for Science and Innovation, dated 09/25/08.
Source: http://www.faseb.org/portals/2/pdfs/opa/2008/ObamaFactSheetScience.pdf
Status:The NIH budget in FY2009 was enacted at $30.5B. This was the amount to "double." The FY2009 authorization was supplemented by $10.4B under the American Recovery and Reinvestment Act (ARRA) of 2009. The following represents NIH budget authorizations during subsequent year:

FY2010....$31.2B
FY2011....$30.9B
FY2012....$30.8B
FY2013....$29.1B
FY2014....$30.1B
FY2015....$29.3B
FY2016....$31.3B
FY2017....$30.2B (Requested)

As reflected above, the promised "steady increases" in the NIH budget did not happen during President Obama's two terms in office.

This promise was not fulfilled.
0.00
Health & Human Services GPA0.66