Campaign Promises

Cabinet/Departments -> Health & Human Services -> Medicare


ItemHealth & Human Services
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