Campaign Promises

Cabinet/Departments -> Health & Human Services -> Health Care System Overhaul


ItemHealth & Human Services
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.
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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.
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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.
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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.
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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.
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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.
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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