Highlights:
VIDEO: May 2015: Trump Promised Not To Cut Social Security, Medicare, Or Medicaid. According to the Daily Signal via YouTube, “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid. Every other Republican is going to cut, and even if they wouldn’t, they don’t know what to do because they don’t know where the money is. I do. I do.” [Daily Signal via YouTube, 5/21/15]
In Trump’s Campaign Launch He Promised To “Save Medicare, Medicaid, And Social Security Without Cuts.” According to PolitiFact, “Protecting Medicare was was one of Trump’s earliest campaign pledges. ‘Save Medicare, Medicaid and Social Security without cuts. Have to do it,’ he said in his presidential campaign announcement speech. So far, the promise of Medicare remains in force. There have been no cuts in services or a change in the government’s responsibility to fund the program. That said, Medicare’s resources to pay for those services has shrunk, and both Trump and House Republicans have proposed ways to trim Medicare spending over the next decade.” [PolitiFact, 3/20/19]
Trump Repeatedly Attacked His Democratic Critics And Falsely Asserted He Would Not Make Cuts To Medicare In His 2021 Fiscal Budget. According to Newsweek, “In a number of his few tweets mentioning Social Security, Medicare or Medicaid, the president also went after Democrats. ‘We will not be touching your Social Security or Medicare in Fiscal 2021 Budget. Only the Democrats will destroy them by destroying our Country’s greatest ever Economy!’ he tweeted Saturday, after sharing in 2017: ‘Democrats purposely misstated Medicaid under new Senate bill—actually goes up.’” [Newsweek, 2/12/20]
2020: Trump Promised During His State Of The Union He Would “Always Protect Your Medicare And Social Security.” According to Mother Jones, “During his state of the union address on Tuesday, President Donald Trump promised that he would protect Americans’ health care. ‘We will always protect your Medicare and your Social Security,’ he said. But that’s not what he said two weeks ago. During a January interview at the World Economic Forum in Davos, Switzerland, CNBC’s Joe Kernen asked if cuts to entitlements, a euphemism for programs like Medicare and Social Security, would ever be on his agenda. ‘At some point they will be,’ Trump answered. ‘It’ll be toward the end of the year. The growth is going to be incredible. And at the right time, we will take a look at that.’” [Mother Jones, 2/4/20]
2023: Trump Told Republicans Not To Target Medicare Or Social Security In Debt Ceiling Fight. According to Politico, “Former President Donald Trump issued a warning to Republican lawmakers on Friday: Don’t lay a finger on entitlement programs as part of the debt ceiling showdown with the White House. ‘Under no circumstances should Republicans vote to cut a single penny from Medicare or Social Security,’ Trump said in a video message.” [Politico, 1/20/23]
Trump: “Under No Circumstances Will We Allow Anyone To Cut Medicare Or Social Security For Our Nation.” According to the Palm Beach Post, “Former President Donald Trump on Monday kicked off his first public speech in Palm Beach County since launching his White House comeback bid with salvos at two fellow Florida Republicans, one a seemingly erstwhile ally and the other a threatening potential rival. In the opening remarks of his Presidents Day speech to a fan club at the Palm Beach Airport Hilton, Trump vowed that ‘under no circumstances will we allow anyone to cut Medicare or Social Security for our nation.’” [Palm Beach Post, 2/21/23]
Pro-Trump Ads Focused On His Support Of Medicare. According to the Wall Street Journal, “Many of the pro-Trump ads on television have focused on Medicare and Social Security and have reflected the candidate’s own efforts to attack DeSantis for his past support while in Congress of scaling back those benefits, in an effort to hurt his standing with older voters.” [Wall Street Journal, 6/26/23]
Trump Attacked DeSantis As A “Wheelchair Over The Cliff Kind Of Guy” Over His Stance On Medicare. According to Politico, “While the GOP once more actively pushed for changing both programs’ benefits, Trump has separated the party into two distinct camps as he attacks Florida Republican Gov. Ron DeSantis as a ‘wheelchair over the cliff kind of guy’ for supporting a congressional budget that alters Medicare. Both Republican camps and even some Democrats agree that Trump’s moves are politically effective. But some GOP members are angry to see their party freshly divided over fiscal austerity.” [Politico, 3/1/23]
A Main Focus Of Trump’s Attacks On DeSantis Were About Medicare. According to Reuters, “A main focus of Trump's attacks has been Social Security - the federal pension system - and Medicare. Trump has repeatedly accused DeSantis of wanting to ‘destroy’ those benefits and has criticized the Florida governor 43 times on those issues since November, with the attacks intensifying since March, according to the analysis.” [Reuters, 5/17/23]
MAGA, Inc. Launched A $1.3 Million National Ad Buy Attacking Ron DeSantis On His Past Support For Medicare Cuts. According to Politico, “A super PAC aligned with former President Donald Trump is launching early, national attack ads hitting Ron DeSantis over the Florida governor’s past support for cuts to Social Security and Medicare. ‘Think you know Ron DeSantis? Think again,’ a narrator says at the start of the ad, which the super PAC posted on Twitter Thursday afternoon. ‘In Congress, DeSantis voted three separate times to cut Social Security.’ The ad closes: ‘The more you see about DeSantis, the more you see he doesn’t share our values. He’s not ready to be president.’ The ads will run on Fox News Channel and CNN, and will cost MAGA, Inc., the super PAC, nearly $1.3 million for a week’s worth of spots. The ads will begin airing on Friday, according to AdImpact, a company tracking ad buys.” [Politico, 3/30/23]
Trump’s Super PAC Released “Hat” Ad Attacking DeSantis On Cutting Medicare. According to the Daily Caller, “A Super PAC tied to former President Donald Trump will release an advertisement Wednesday morning going after Republican Florida Gov. Ron DeSantis for voting to cut social security and Medicare. The Daily Caller first obtained a copy of the ad, titled ‘Hat,’ which shows a man picking between a DeSantis hat or Trump’s signature ‘Make America Great Again’ hat.” [Daily Caller, 4/26/23]
MAGA, Inc Ran Two Ads In New Hampshire That Would Air On WMUR And Blasted DeSantis On Cuts To Medicare. According to NH Journal, “On Monday came news that MAGA, Inc., the Super PAC supporting Trump’s 2024 GOP primary bid, made its first broadcast TV buy of the campaign, part of a $1.26 million push in the early states of Iowa and New Hampshire. The two ads, which will air on WMUR, both target DeSantis over ‘voting to cut Social Security or Medicare,’ a reference to then-Congressman DeSantis’ vote for a GOP plan to slow federal spending and reform entitlements.” [NH Journal, 5/1/23]
Trump’s FY 2019 Budget Sought To Cut Medicare By $236 Billion Over 10 Years. According to Reuters, “President Donald Trump proposed a budget on Monday that calls for cuts in domestic spending and social programs such as Medicare and seeks a sharp increase in military spending and funding for a wall on the Mexican border. While running for president in 2016, Trump pledged to leave popular benefit programs such as Medicare and Social Security untouched, but his new budget proposal would reduce Medicare spending by $236 billion over the next 10 years. The White House argued, however, that the reduced spending would come through reforms to the government health insurance program for the elderly, not benefit cuts.” [Reuters, 2/12/18]
2019: Trump Proposed A FY 2020 Budget That Cut Medicare By $845 Billion Over 10 Years. According to the Washington Post, “The Trump budget also promises to slow spending on Medicare, the federal program that gives health insurance to older Americans, by $845 billion over the next 10 years, in party by limiting fraud and abuse and payments to hospitals. During the 2016 presidential campaign, Trump said he would not cut Medicare or Social Security, the retirement program for the elderly, but his budget last year also included a proposed cut of more than $550 billion to the program.” [Washington Post, 3/11/19]
Trump’s FY 2021 Budget Cut $500 Billion From Medicare Over 10 Years. According to the Center on Budget Policy Priorities, “President Trump’s 2021 budget proposes about $500 billion in net Medicare spending reductions over ten years (see table), most of which would come from reducing payments to health care providers and not affect beneficiaries directly.” [Center on Budget Policy Priorities, 2/13/20]
Trump’s FY 2021 Budget Proposal Called For Over $4.4 Trillion In Cuts To Medicaid, Medicare, And Entitlement Programs. According to the Washington Times, “President Trump is proposing to balance the federal budget within 15 years, ‘shrink’ the federal government and extend food stamp work requirements to Medicaid and housing programs in a $4.8 trillion spending plan being released Monday. The plan would reduce spending by $4.4 trillion equally from discretionary and mandatory programs such as Medicare over the next decade. The plan also includes $2 billion for the border wall, with officials saying the administration is approaching 80% of the money needed to finish the wall.” [Washington Times, 2/9/20]
VIDEO: January 2020: Asked If Trump Would Be Willing To Do Some Of The Things He Wasn’t Willing To Do In The Past “In Terms Of Medicare,” Trump Said, “Well, We’re Going-- We’re Going Look.” According to CNBC via YouTube, “KERNEN: One last question. TRUMP: Go ahead. KERNEN: Entitlements ever be on your plate? TRUMP: At some point they will be. We have tremendous growth. We’re going to have tremendous growth. This next year I-- it’ll be toward the end of the year. The growth is going to be incredible. And at the right time, we will take a look at that. You know, that’s actually the easiest of all things, if you look, cause it’s such a— […]KERNEN: If you’re willing-- TRUMP: --big percentage. KERNEN: --to do some of the things that you said you wouldn’t do in the past, though, in terms of Medicare-- TRUMP: Well, we’re going-- we’re going look. We also have-- assets that we’ve never had. I mean we’ve never had growth like this.” [CNBC via YouTube, 1/22/20]
VIDEO: January 2020: Asked If “Entitlements Ever Be On Your Plate?” Trump Said, “At Some Point They Will Be.” According to CNBC via YouTube, “KERNEN: Entitlements ever be on your plate? TRUMP: At some point they will be. We have tremendous growth. We’re going to have tremendous growth. This next year I-- it’ll be toward the end of the year. The growth is going to be incredible. And at the right time, we will take a look at that. You know, that’s actually the easiest of all things, if you look.” [CNBC via YouTube, 1/22/20]
VIDEO: March 2020: At A Scranton Town Hall, Trump Said He Intended To Cut Entitlement Programs; “Oh, We’ll Be Cutting.” According to Fox News via YouTube, “MACCALLUM: If you, if you don’t cut something in entitlements, you will never really deal with the debt.” TRUMP: Oh, we’ll be cutting, but we’re also going to have growth like you’ve never seen before.” [Fox News via YouTube, 3/5/20]
Ramesh Ponnuru Tweeted That A GOP Congressman Had Told Reporters That Trump Had Said He Was Open To Reform Medicare And Social Security “On The First Day Of His Second Term.” According to a tweet by Ramesh Ponnuru, “GOP congressman tells reporters that Trump told him he is open to reform of Medicare, SS “on the first day of his second term.” [Twitter, 12/14/17]
Trump Told A Republican Member Of Congress That He Would Not Touch Social Security “Until The First Day Of His Second Term.” According to Business Insider, “When asked about Trump's level of seriousness on the issue, the Republican said the president would not touch Social Security ‘until the first day of his second term, he told me once.’” [Business Insider, 12/15/17]
March 2019: Trump’s Justice Department Backed Full Overturning Of Affordable Care Act, Which Would Cost 20 Million Americans Their Health Insurance. According to Vox, “This week, his Justice Department filed a legal brief arguing that a judge should find Obamacare unconstitutional — a decision that would turn the insurance markets back into the Wild West and eliminate Medicaid coverage for millions of Americans. By at least one estimate, a full repeal could cost 20 million Americans their health care coverage.” [Vox, 3/27/19]
The ACA Gradually Closed The Medicare Coverage Gap For Prescription Drugs. According to the Center for Medicare and Medicaid Services, “The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage during which beneficiaries had to pay the full cost of their prescriptions out of pocket, after hitting their initial coverage limit, and before catastrophic coverage for prescriptions took effect. The gap is known as the donut hole. Because of the Affordable Care Act, the donut hole has been narrowing each year, and will be closed by 2020. Because of the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole received a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts and savings on covered brand-name and generic drugs. People with Medicare Part D who are in the donut hole in 2017 will receive discounts and savings of 60 percent on the cost of brand name drugs and 49 percent on the cost of generic drugs.” [Center for Medicare and Medicaid Services, 1/13/17]
2010 - 2016: 11.8 Medicare Beneficiaries Received $26.8 Billion In Discounts On Prescription Drugs Through The ACA’s Provisions. According to the Center for Medicare and Medicaid Services, “The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continue to save on prescription drugs and see improved benefits in 2016 as a result of the Affordable Care Act. More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary – since the enactment of the Affordable Care Act. In 2016 alone, over 4.9 million seniors and people with disabilities received discounts of over $5.6 billion, for an average of $1,149 per beneficiary. This is an increase in savings compared to the 2015 information released this time last year, when 5.2 million Medicare beneficiaries received discounts of $5.4 billion, for an average of $1,054 per beneficiary.” [Center for Medicare and Medicaid Services, 1/13/17]
If ACA Were Reversed, The Donut Hole In Medicare Drug Coverage Would Increase. According to CNBC, “Depending on if and how the law is scrapped, retirees and those headed for retirement could face higher costs for prescription drugs and preventive care. Though Obamacare primarily dealt with how to provide health insurance coverage for those who didn’t have it, the law also delivers free preventive services to Medicare beneficiaries and lowers their out-of-pocket prescription drug costs […] Right now there’s something called the ‘donut hole’in Medicare prescription drug coverage, known as Medicare Part D. The donut hole means that older Americans pay a higher percentage of their drug costs when they spend between roughly $1,250 and $4,950 out of pocket in 2017, said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare policy program. (See chart below.) ‘The ACA reduced drug costs for seniors on Part D with relatively high drug bills, which could be due to one really high-priced drug for a condition like hepatitis C or because they take multiple brand-name drugs,’ Neuman said. Roughly 9 million of the 38.7 million people, about 25 percent, enrolled in Part D have drug spending high enough to reach the coverage gap, according to the Medicare Payment Advisory Commission.” [CNBC, 2/7/17]
If The ACA Were Left Unchanged, The Medicare Drug Coverage Donut Hole Would Close By 2020. According to CNBC, “If the law is left unchanged, the Affordable Care Act will close the donut hole by 2020.” [CNBC, 2/7/17]
Trump’s Proposed FY2020 Budget Would Change The Way Out-Of-Pocket Drug Costs Are Calculated, Leading To Senior Spending Longer In The Coverage Gap. According to CNBC, “The president’s proposed 2020 budget, released Monday, calls for allowing Medicare to negotiate lower prices with pharmaceutical companies and would cap how much beneficiaries pay out-of-pocket under Part D prescription drug coverage, among other provisions. Yet it also would get rid of some help that beneficiaries receive for their medicines. On top of eliminating help with generic drug costs for low-income Medicare recipients, the budget would stop allowing manufacturer discounts to count toward a beneficiary’s out-of-pocket costs during the so-called coverage gap under Part D. ‘If those discounts are no longer counted, it means people would spend longer in the coverage gap and spend more out of pocket,’ said Mary Johnson, Social Security and Medicare policy analyst for The Senior Citizens League. ‘Those discounts currently are 70 percent of the cost of a drug.’ Medicare Part D’s coverage gap, or ‘donut hole,’ is the time between a drug plan’s coverage limit ($3,820 for 2019) and the threshold for qualifying for catastrophic coverage ($5,100 for 2019), which is when your share of the cost drops. While Medicare beneficiaries now pay 25 percent for brand-name drugs during that gap — the same share before reaching the drug plan’s limit — they also have been able to count manufacturer discounts toward their out-of-pocket costs while in the gap. That helps them reach the catastrophic phase of coverage faster.” [CNBC, 3/11/19]
The Innovation Authority Provision Of The ACA Allowed Medicare And Medicaid To Test Strategies For Paying For Medical Care In Attempts To Lower Costs And Improve Quality Of Care. According to the New York Times, “The crucial provision is known as the innovation authority. It allows Medicare and Medicaid to test strategies for paying for medical care in pursuit of ways to lower costs and improve the quality of care. It is a very broad authority. Before Obamacare, most changes to Medicare required special legislation from Congress. Congress can move slowly, and medical industries tend to oppose provisions that would result in less spending on treatment. With the innovation authority, the Department of Health and Human Services can introduce various experiments, and it has the power to take successful pilot programs national, without involving Congress.” [New York Times, 7/11/19]
July 2019: Trump Signed Two Executive Orders Pertaining To Health Care That Would Have Been Effectively Gutted If The ACA Was Erased. According to the New York Times, “In court, the Trump administration is trying to get all of Obamacare erased. But at the White House, President Trump and his health officials are busily using the law to pursue key proposals. Last week, the president highlighted a policy in the works meant to narrow the gaps between what drugs cost in the United States and overseas. On Wednesday, he signed an executive order to transform care for patients with kidney disease. Both measures were made possible by a provision in the Affordable Care Act, and both would be effectively gutted if the administration’s position prevailed in court. In between, administration lawyers told a receptive panel of judges in New Orleans that the entire Affordable Care Act should be overturned.” [New York Times, 7/11/19]
The Trump Administration Welcomed The Power Provided By The Innovation Authority Provision. According to the New York Times, “That’s a power that has been welcomed in an administration that has embraced broad executive power. Obama administration officials liked the innovation center power, too. But the Trump administration has gone further, experts said, in pursuing a variety of interesting ideas about how to reform health care delivery. Alex Azar, the secretary of Health and Human Services, has pointed enthusiastically to this authority at times, telling reporters last year that his ‘pen has a lot of power.’” [New York Times, 7/11/19]
Trump’s Executive Order Called For Promoting Private Medicare Advantage Plans. According to Vox, “Trump signed an executive order on October 3 to ’protect and improve’ Medicare with a series of somewhat vague proposals that are aimed at expanding a more market-based approach to Medicare. There are some provisions in this executive order that are largely uncontroversial, like improving network adequacy, expanding access to tele-health, or reducing the time between drugs being approved by the FDA and their being covered by Medicare. But the Trump administration’s explicit intent to promote Medicare Advantage, a program that allows Medicare enrollees to opt into private qualified plans, could have major implications for the current Medicare system. The order is a bit of a ‘Rorschach test,’ said Kaiser Family Foundation Medicare expert Tricia Neuman, one with many possibly interpretations.” [Vox, 10/7/19]
Trump’s Executive Order Could Have Hurt Two-Thirds Of Medicare Enrollees. According to Vox, “‘The biggest implication is that despite the phrasing that this is designed to protect and improve Medicare, to the extent there are improvements they are all focused on the private Medicare Advantage plans that are by most measures overpaid compared to normal Medicare,’ Paul Van de Water of the liberal think tank Center on Budget and Policy Priorities said of the plan. ‘The Executive Order continues to privilege the Medicare Advantage plans and make some proposals that could disadvantage two-thirds of the Medicare enrollees.’” [Vox, 10/7/19]
Trump’s Executive Order Changed Enrollment Procedures To Present Private Plans As Prominently As Traditional Fee-For-Service Medicare. According to the Washington Post, “President Trump is scheduled to issue an order Thursday that will expand the private-sector version of Medicare, as he slams some Democratic presidential candidates’ plans to build the program into a government-financed health system. The executive order will direct federal health officials to make changes to Medicare Advantage, the private managed care plans currently enrolling 22 million people — one-third of the participants in the federal insurance program for Americans who are 65 and older or have disabilities. The changes are intended, in part, to give Medicare Advantage plans the option to cover a greater array of health-related services, such as adult day care. They also will foster long-distance ‘Telehealth’ services that may be useful especially in rural areas. And they will revise enrollment procedures for people joining Medicare or renewing their membership so that the private health plans are presented as prominently as the traditional ‘fee-for-service’ form of Medicare in which the program pays for patients to go to whichever doctors they choose.” [Washington Post, 10/3/19]
Trump’s Executive Order Called For Market Based Pricing Which Would Drive Up Medicare Costs Pushing Seniors To The Medicare Advantage Program. According to Salon, “Watch out, older Americans and people with disabilities! President Trump just announced a plan to give corporate health insurers more control over your health care. His new executive order calls for ‘market-based’ pricing, which would drive up costs for everyone with Medicare, eviscerate traditional Medicare, and steer more people into for-profit ‘Medicare Advantage’ plans. Seema Verma, the Trump appointee who heads the Centers for Medicare and Medicaid Services (CMS), may not have warned Trump about the slew of government audits revealing that many Medicare Advantage plans pose ‘an imminent and serious risk to the health of… enrollees.’ They also overcharge taxpayers to the tune of $10 billion a year. In the last few years alone, CMS’ limited audits have highlighted major issues with Medicare Advantage plans. Reports from the Department of Health and Human Services Office of the Inspector General (OIG) and Government Accountability Office (GAO) have underscored these issues. They have recommended that CMS increase its oversight of Medicare Advantage plans and its enforcement efforts.” [Salon, 10/5/19]
Center For American Progress: Trump’s Executive Order Actively Attempted To Privatize And Undermine Medicare. According to the Center For American Progress, “President Trump has laid out a plan to privatize Medicare and undermine the program, breaking his promise that ‘no one will lay a hand on your Medicare benefits.’ Furthermore, he is trying to scare seniors away from supporting congressional proposals that would genuinely improve Medicare beneficiaries’ access to health care and financial security. Although seniors need better protection against out-of-pocket medical costs and better access to care providers, the changes Trump has proposed will only make things worse.” [Center For American Progress, 10/11/19]
Trump’s Executive Order Proposed Changes That Could Have Led To Higher Costs For Seniors And Potentially Expose Some To Surprise Medical Bills. According to NPR, “Vowing to protect Medicare with ‘every ounce of strength,’ President Trump spoke last week to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt out. The bottom line: The proposed changes might make it a bit simpler to find a doctor who takes new Medicare patients, but it could lead to higher costs for seniors and potentially expose some to surprise medical bills, a problem from which Medicare has traditionally protected consumers. ‘Unless these policies are thought through very carefully, the potential for really bad unintended consequences is front and center,’ says economist Stephen Zuckerman, vice president for health policy at the Urban Institute.” [NPR, 10/8/19]
Trump’s Executive Order Failed To Address Common Medicare Problems Such As High Out Of Pocket Costs And Difficulties Navigating Medicare Advantage Networks. According to the Center For American Progress, “President Trump rolled out the executive order in a speech at a retirement community in Florida, during which he echoed his administration’s previous attacks on progressive health reform proposals by referring to them as ‘Medicare for None.’ In fact, several recent congressional proposals would offer new choices for coverage, expand the benefits of insurance, and strengthen Medicare benefits for the elderly. Unlike these Medicare for All-type proposals, Trump’s plan fails to address some more common problems in Medicare, such as high out-of-pocket costs or difficulties navigating Medicare Advantage networks.” [Center For American Progress, 10/11/19]
Rules In The Executive Order May Have Lifted The Cap On The Amount Doctors Can Balance-Bill Some Patients, Leaving Some Patients Liable To Pay More And Potentially Exposed To Surprise Billing. According to NPR, “‘It could mean a lot of things,’ says Joseph Antos at the American Enterprise Institute, including possibly letting seniors make a contract with an individual doctor or buy into something that isn't traditional Medicare or the current private Medicare Advantage program. ‘Exactly what that looks like is not so obvious.’ Others say eventual rules might result in lifting the 9.25% cap on the amount doctors can balance-bill some patients. Or the rules around fully ‘opting out’ of Medicare might ease so physicians would not have to divorce themselves from the program or could stay in for some patients, but not others. That could leave some patients liable for the entire bill, which might lead to confusion among Medicare beneficiaries, critics of such a plan suggest. The result may be that ‘it opens the door to surprise medical billing if people sign a contract with a doctor without realizing what they're doing,’ says Jost.” [NPR, 10/8/19]
The Executive Order Issued By The Trump Administration Directed Federal Health Officials To Increase The Private Sector Role Within The Medicare Advantage Program. According to the Washington Post, “President Trump is scheduled to issue an order Thursday that will expand the private-sector version of Medicare, as he slams some Democratic presidential candidates’ plans to build the program into a government-financed health system. The executive order will direct federal health officials to make changes to Medicare Advantage, the private managed care plans currently enrolling 22 million people — one-third of the participants in the federal insurance program for Americans who are 65 and older or have disabilities. The changes are intended, in part, to give Medicare Advantage plans the option to cover a greater array of health-related services, such as adult day care. They also will foster long-distance ‘Telehealth’ services that may be useful especially in rural areas. And they will revise enrollment procedures for people joining Medicare or renewing their membership so that the private health plans are presented as prominently as the traditional ‘fee-for-service’ form of Medicare in which the program pays for patients to go to whichever doctors they choose.” [Washington Post, 10/3/19]
Trump Signed An Executive Order That Expanded Tax-Free Medical Savings Accounts (MSAs). According to CNBC, “A little-used Medicare option is getting a big push from the White House. An executive order signed on Thursday by President Donald Trump includes a call for expanding access to medical savings accounts, or MSAs. While details are thin, the move echoes other efforts by the administration geared at making tax-advantaged savings options more readily available to Medicare recipients. Broadly, the executive order is about bolstering Advantage Plans, which are used by about 36% — 22 million — of Medicare’s 60.8 million beneficiaries. These plans, offered through private insurance companies, deliver Medicare Part A (hospital coverage) and Part B (outpatient care) benefits and often extras such as limited dental and vision coverage. They also typically include Part D prescription drug coverage. While the use of Advantage Plans has been steadily rising, a small fraction of Medicare beneficiaries — about 6,000 — are estimated to use MSA plans, according to the Kaiser Family Foundation.” [CNBC, 10/4/19]
Trump Advocated Using The Plan As A Tax Shelter And Encouraged Higher-Income Individuals To Benefit From The Tax Exemption. According to the Center for American Progress, “President Trump has previously proposed turning MSAs into a tax shelter, which would chiefly benefit the wealthy. Trump’s FY 2020 budget proposed allowing seniors to deposit additional funds into MSAs beyond the plan’s contribution, as they can with HSAs. Data on HSA contributions show that higher-income individuals are more likely to contribute toward accounts and to benefit more from the tax exemption.” [Center For American Progress, 10/11/19]
Consumer Advocates Argued That The Expansion Of MSAs Would Primarily Support Wealthier And Healthier Beneficiaries. According to CNBC, “While it’s uncertain what regulatory changes would be proposed to expand access to MSAs, Trump’s 2020 budget proposal included allowing Medicare beneficiaries to contribute to such accounts with annual contribution limits matching those on HSAs. For 2019, those caps are $3,500 for individual and $7,000 for family coverage. People age 55 or older can put an extra $1,000 in per year. Consumer advocates view the expansion of such tax-advantaged accounts as a move that would largely benefit wealthier households, which are more likely to have extra cash to put in the accounts — and often leave it there as an investment instead of withdrawing the money to pay for medical expenses. Expanding MSAs would ‘help the healthy and wealthy,’ said David Lipschutz, associate director at the Center for Medicare Advocacy. ‘That shouldn’t be a health policy goal.’” [CNBC, 10/4/19]
As The Trump Administration Pushed For Increased Enrollment In Medicare Advantage Program, State Officials Expressed Concerns As Seniors Faced Challenges And Glitches When Attempting To Use The Medicare Sign-Up Webpage Operated By CMS. According to North Carolina Health News, “A newly revised Medicare sign-up page can produce drastically inflated costs for some drugs, incorrect premiums for low-income people, and other ‘worrisome’ results, say North Carolina health officials who work to make sure people over 65 get appropriate benefits […] Users found an initial revamp lacking this year and more glitches are emerging as the Trump administration pushes beneficiaries to sign up for Medicare Advantage coverage. These privately run Medicare plans often require more complicated user calculations.” [North Carolina Health News, 10/22/19]
The Trump Administration’s Redesigned Medicare Cost Finder Website Frequently Malfunctioned And Offered Inaccurate Cost Estimates To Seniors Attempting To Compare Insurance Plans. According to ProPublica, “The federal government recently redesigned a digital tool that helps seniors navigate complicated Medicare choices, but consumer advocates say it’s malfunctioning with alarming frequency, offering inaccurate cost estimates and creating chaos in some states during the open enrollment period […] In Nebraska, miscalculations offered through the new Medicare Plan Finder were so worrisome that the state in late October temporarily shut down a network of about 350 volunteer Medicare advisers for a day because without the tool, narrowing the numerous choices — more than 4,000 Medicare plans are available nationwide — down to three top selections would be nearly impossible. Days later, EnvisionRxPlus, a prescription drug plan, sent an email to independent insurance brokers nationwide recommending they not use the Medicare Plan Finder because of incorrect estimates on drug prices and patient deductibles. (It’s a warning they had yet to retract some two weeks later.)” [ProPublica, 11/25/19]
CMS Failed To Warn Users Of The Potential Inaccuracies Cause By The Redesign. According to ProPublica, “As of Friday, there was no alert on the federal website warning of possible inaccuracies because of the redesign.” [ProPublica, 11/25/19]
CMS Attempted To Downplay The Malfunctions In The Online Tool That Was Redeveloped For $11 Million. According to ProPublica, “The Centers for Medicare and Medicaid Services, the government agency that administers federal health programs, acknowledged in a statement that some problems have been reported but said development of the redesigned tool, which cost about $11 million, was an ‘iterative’ process. The statement said CMS did ‘extensive consumer testing … to ensure that the information that is displayed is complete, streamlined, understandable, and is in plain language.’ CMS said it previewed the new plan finder in June and began ‘road-testing’ it in July, saying ‘stakeholder feedback led to enhancements’ that were implemented before a public launch on Aug. 27. Updates have continued as users report issues, according to the statement. CMS said this is the first time since the Medicare Plan Finder was developed in 2005 that the tool has been redesigned. The complete rebuild was necessary, it said, because legacy technology and ‘proprietary software’ couldn’t keep pace with ‘the needs of today’s digital audience’ and because the explosion in options available to seniors under various plans.” [ProPublica, 11/25/19]
Lawmakers, Members Of The Healthcare Industry, And Healthcare Advocates Expressed Concerns Over The Error-Prone Misinformation Provided On The Medicare “Plan Finder” Website. According to 90.7 WMFE, “Medicare’s overhauled Plan Finder debuted at the end of August, and 2020 plan information was added in October. But over the past three months, problems with Plan Finder have been reported to CMS by the National Association of Insurance Commissioners, the National Association of Health Underwriters and state and national consumer advocates. The problems cited included inaccurate details about prices, covered drugs and dosages, and difficulty sorting and saving search results, among other things.” [90.7 WMFE, 12/7/19]
National Council On Aging: Millions Of People Are Going To Be Absolutely Affected By The Malfunctioning Website. According to ProPublica, “‘Millions of people are going to be absolutely affected,’ said Ann Kayrish, senior program manager for Medicare at the National Council on Aging. ‘And you hate to think about millions of people having the wrong plan. That’s kind of crazy.’” [ProPublica, 11/25/19]
Center For Medicare Advocacy: Addressing The Problems On The Website Is ‘Like A Game Of Whack-A-Mole.’ According to ProPublica, “‘It’s not like there’s one consistent problem that you can fix and then be addressed,’ said David Lipschutz, associate director of the Center for Medicare Advocacy. ‘It’s really like a game of whack-a-mole.’” [ProPublica, 11/25/19]
The Average Fine For Nursing Homes That Endangered Or Injured Their Residents Dropped From $41,260 In 2016 To $28,405 Under The Trump Administration Due To Industry Pressure. According to Kaiser Health News, “The Trump administration’s decision to alter the way it punishes nursing homes has resulted in lower fines against many facilities found to have endangered or injured residents. The average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Barack Obama’s final year in office, federal records show. The decrease in fines is one of the starkest examples of how the Trump administration is rolling back Obama’s aggressive regulation of health care services in response to industry prodding. Encouraged by the nursing home industry, the Trump administration switched from fining nursing homes for each day they were out of compliance — as the Obama administration typically did — to issuing a single fine for two-thirds of infractions, the records show.” [Kaiser Health News, 3/15/19]
The Trump Administration Exempted Nursing Homes From Health And Safety Rules And Allowed Them To Require Residents To Sign Forced Arbitration Agreements. According to Kaiser Health News, “Since Trump took office, the administration has heeded multiple nursing home complaints about zealous oversight. It granted facilities an 18-month moratorium from being penalized for violating eight new health and safety rules. It also revoked an Obama-era rule barring homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than go to court.” [Kaiser Health News, 3/15/19]
By Switching From Per-Day To Per-Instance Fines, Nursing Homes Only Have To Pay $13,905 For Violations, Even Violations That Result In Residents Being Placed In Immediate Harm. According to Kaiser Health News, “But switching to a preference for per-instance fines means much lower penalties, since fines are capped at $21,393 whether they are levied per instance or per day. Homes that pay without contesting the fine receive a 35 percent discount, meaning they currently pay at most $13,905. Those maximums apply even to homes found to have committed the most serious level of violations, which are known as immediate jeopardy because the home’s practices place residents at imminent risk of harm. For instance, a Mississippi nursing home was fined $13,627 after it ran out of medications because it had been relying on a pharmacy 373 miles away, in Atlanta. CMS also reduced $54,600 in daily fines to a single fine of $20,965 for a New Mexico home where workers hadn’t been properly disinfecting equipment to prevent infectious diseases from spreading.” [Kaiser Health News, 3/15/19]
June 2018: CMS Told Nursing Home Inspectors They Did Not Need To Fine Facilities For Violations Unless They Resulted In, “Serious Injury, Harm, Impairment, Or Death.” According to Kaiser Health News, “The frequency of immediate-jeopardy fines may further decrease. CMS told inspectors in June that they were no longer required to fine facilities unless immediate-jeopardy violations resulted in ‘serious injury, harm, impairment or death.’ Regulators still must take some action, but that could be ordering the home to arrange training from an outside group or mandating specific changes to the way the home operates.” [Kaiser Health News, 3/15/19]
Coalition Against Surprise Medical Billing: Americans Make About 137 Million Emergency Room Visits Per Year. “At Least 1 In 6 Patients” With Health Insurance Will Receive A Surprise Medical Bill. According to the Coalition Against Surprise Medical Billing, “Surprise medical billing can break the bank for hardworking Americans with bills totaling thousands of dollars – often in cases where patients were not able to choose their doctor. For example, every year, Americans make about 137 million visits to emergency rooms in the United States. At least 1 in 6 patients who have health insurance will receive a surprise medical bill from a provider or specialist who treated them. Importantly, not all doctors or local hospitals are the culprits behind surprise medical bills. The real issue is when clinical specialists or providers choose not to participate in health insurance providers’ networks – or if they do not meet the standards for inclusion in a network – and can then demand a blank check from patients for their services. These specialty providers are likely to charge substantially more than their peers in other specialties, not accept private insurance, and are not actively chosen by patients. Studies have found that surprise medical bills are most likely to come from emergency medicine physicians, anesthesiologists, radiologists, and pathologists.” [Coalition Against Surprise Medical Billing, 1/28/20]
Trump’s Medicare Advantage Executive Order Made It Easier For Providers To Opt Out Of Medicare Which Potentially Exposed Seniors To Surprise Medical Bills. According to NPR, “Vowing to protect Medicare with ‘every ounce of strength,’ President Trump spoke last week to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt out. The bottom line: The proposed changes might make it a bit simpler to find a doctor who takes new Medicare patients, but it could lead to higher costs for seniors and potentially expose some to surprise medical bills, a problem from which Medicare has traditionally protected consumers.” [NPR, 10/8/19]
Prior To Trump’s Executive Order Fewer Than 1% Of Physicians Chose To Opt-Out Of Participating In Medicare. According to NPR, “Right now, the vast majority of physicians agree to accept what Medicare pays them and not charge patients for the rest of the bill, a practice known as balance billing. Physicians (and hospitals) have complained that Medicare doesn’t pay enough, but most participate anyway […] Alternatively, physicians can ‘opt out’ of Medicare and charge whatever they want. But they can’t change their mind and try to get Medicare payments again for at least two years. Fewer than 1% of the nation’s physicians have currently opted out.” [NPR, 10/8/19]
Medicare Protected Patients From Balance Billing, Limiting Charges Physicians Can Levy Against Patients To Only 9.25% Above Medicare’s Regular Rates. According to NPR, “Medicare limits balance billing. Physicians can charge patients the difference between their bill and what Medicare allows, but those charges are limited to 9.25% above Medicare’s regular rates. But partly because of the paperwork hassles for all involved, only a small percentage of doctors choose this option.” [NPR, 10/8/19]
Medicare Paid Nothing To Providers Who Opted-Out, Leaving Patients To Pay The Full Amount. According to the Center on Budget and Policy Priorities, “Almost all physicians and practitioners registered with Medicare (96 percent) are participating providers. Participating providers accept Medicare’s fee schedule rates as full payment for their services, and beneficiaries generally pay 20 percent of the scheduled amount as coinsurance. A few physicians (4 percent) are non-participating providers. Non-participating providers may charge 15 percent more than what Medicare pays, and beneficiaries are liable for that additional amount on top of the usual coinsurance. Very few physicians and dentists (0.7 percent of practitioners) opt out of Medicare. Opt-out providers may charge whatever they and their Medicare patients agree to through a private contract; Medicare pays nothing, and the patient must pay the entire amount.” [Center on Budget and Policy Priorities, 11/7/19]
Center on Budget and Policy Priorities: Beneficiaries Could Receive Surprise Billing If They Sign A Private Contract Without Fully Understanding Its Implications. According to the Center on Budget and Policy Priorities, “The Medicare law protects beneficiaries from excessive charges by limiting private contracting in several ways. Physicians who wish to opt out of Medicare must do so for all patients and all services, and they cannot return to Medicare for two years.[8] Physicians may not contract with patients who are experiencing a medical emergency or are eligible for Medicaid. Relaxing any of these restrictions on private contracting would make it easier for physicians to opt out of Medicare, subject Medicare beneficiaries or the Medicare program to higher costs, reduce access to doctors by low- and moderate-income beneficiaries who could not afford to pay the higher charges, and lead to the development of a two-tier Medicare system. Beneficiaries could also receive surprise medical bills if they signed a private contract without fully understanding its implications.” [Center on Budget and Policy Priorities, 11/7/19]
2019: Trump Said He Would Send Congress A Set Of Principles That Aimed To End Surprise Medical Billing. According to CNN, “The President announced on Thursday that he’s sending a set of principles to Congress that aims to end patients’ responsibility for big charges when they unknowingly are treated by out-of-network doctors or hospitals, often in an emergency situation. ‘In emergency care situations, patients should never have to bear the burden of out-of-network costs they didn’t agree to pay,’ Trump said at press conference Thursday, standing with a family that was billed nearly $18,000 for a urine drug test that would have carried an in-network charge of just $101. ‘No family should be blindsided by outrageous medical bills.’ Half of Americans say shielding people from surprise medical bills should be a top priority for Congress, according to an April Kaiser Family Foundation poll. That ranks behind lowering drug costs and protecting those with preexisting conditions, but ahead of major changes to the nation’s health care system, such as repealing the Affordable Care Act or implementing a national ‘Medicare for All’ plan. The goal is to make sure that consumers who go to an emergency room would only pay what they would if they went to in-network providers, letting insurers and health care professionals work out the remaining payment, Joe Grogan, director of the Domestic Policy Council, told reporters Thursday.” [CNN, 2/9/19]
2021: Rules On Surprise Medical Billing Were Not Proposed And Did Not Go Into Effect Until After Trump Left Office. According to CNN, “Patients would no longer receive surprise medical bills for emergency treatment and certain other health care services from out-of-network providers starting in January under a rule issued Thursday by the Biden administration. The interim final rule starts the process of filling out the No Surprises Act, a contentious and long-delayed bill Congress passed in December and former President Donald Trump signed into law after much lobbying from both insurers and providers. Subject to a 60-day comment period, the rule is the first of several the Biden administration will roll out to implement the law. Under the rule, patients would be responsible only for their in-network cost-sharing for both emergencies and certain non-emergencies where they are unable to choose in-network providers.” [CNN, 7/1/21]
Trump Backed Away From His Pledge To Support Negotiations With Pharmaceutical Companies Over The Price Of Prescription Drugs For Medicare Recipients. According to The Hill, “President Trump is backing off his 2016 campaign pledge to negotiate drug prices for Medicare with pharmaceutical companies, drawing fire from Democrats after months of talks on the issue with Speaker Nancy Pelosi (D-Calif.). During his campaign, Trump famously broke with Republican orthodoxy with his support for having the government negotiate lower drug prices. ‘When it comes time to negotiate the cost of drugs, we are going to negotiate like crazy,’ Trump said in New Hampshire in early 2016. Pelosi’s staff spent months over the course of this year trying to get White House support for her measure to allow the government to negotiate prices for up to 250 drugs per year, with tough financial penalties for companies that refused to come to the table. But after months of holding his fire, Trump is now publicly bashing Pelosi’s bill. And while Trump still talks about the need to lower drug prices in general, he has not proposed an alternative drug price negotiation plan of his own.” [The Hill, 11/24/19]
After Rejecting Speaker Pelosi’s Medicare Price Proposal, The Trump Administration Sought To Quell Criticism About The Rising Cost Of Prescription Drugs By Supporting A Senate Bill Which Did Not Include Medicare Bargaining Authority. According to The Washington Post, “After months of dialogue, the White House and House Speaker Nancy Pelosi have parted ways on Medicare price negotiations that Pelosi advocates and Trump — unlike most Republicans — once supported in principle. Instead Trump is backing a compromise bipartisan bill in the Senate, which does not give Medicare bargaining authority, but forces drugmakers to pay rebates if they raise prices too high […] The pressure is on Trump. A Gallup-West Health poll finds that 66 percent of adults don’t believe the Trump administration has made any progress, or very much progress, in limiting the rising cost of prescription drugs. ‘If I were the president of the United States, facing a very difficult reelection campaign, I would want to have something to show people in this area,’ said political scientist Bill Galston of the Brookings Institution.” [Washington Post, 11/18/19]
2022: The Inflation Reduction Act Allowed Medicare To Negotiate Drug Prices With Pharmaceutical Companies. According to CNBC, “Medicare is poised to renegotiate the prices of some of its most expensive drugs through a historic expansion of its power, which could reduce costs for many seniors as well as federal spending on its prescription drug plan. The changes are tucked inside a massive spending-and-tax bill in Congress that includes $433 billion in investments in health-care and clean energy. House Democrats passed the Inflation Reduction Act on Friday in a 220 to 207 vote along party lines, ending a tortured legislative process that took more than a year. The bill empowers the Health and Human Services Secretary to negotiate prices for certain drugs covered under two different parts of Medicare and punish pharmaceutical companies that don’t play by the rules. The legislation also caps out-of-pocket costs at $2,000 starting in 2025 for people who participate in Medicare Part D, the prescription drug plan for seniors.” [CNBC, 8/12/22]
2023: The Biden Administration Prepared To Announce The First Medicines That Medicare Would Be Allowed To Negotiate Prices On. According to the Washington Post, “The Biden administration is preparing to announce the first 10 medicines it will target under a program that allows the government to negotiate drug prices with pharmaceutical giants, part of a sweeping — and legally contested — campaign to lower costs for seniors on Medicare. The list is expected to arrive within the next two weeks, and industry experts believe it will include some of the most widely prescribed treatments for arthritis, blood disorders, heart disease and diabetes — prompting top manufacturers, including Bristol Myers Squibb, Merck and Johnson & Johnson, to challenge the administration in court.” [Washington Post, 8/18/23]
September 2020: Trump Promised To Send Discount Drug Cards To Seniors Shortly Before The Election Despite Their Questionable Legality. According to the New York Times, “President Trump vowed on Thursday to send $200 discount cards for prescription drugs to 33 million older Americans, a $6.6 billion election-eve promise with dubious legal authority that he announced as part of a speech billed as presenting a long-awaited health care plan.” [New York Times, 9/24/20]
The Drug-Discount Cards Would Be Paid By Tapping The Medicare Trust Fund And Could Have Trump’s Branding On Them. According to Politico, “Caught by surprise by President Donald Trump’s promise to deliver drug-discount cards to seniors, health officials are scrambling to get the nearly $8 billion plan done by Election Day, according to five officials and draft documents obtained by POLITICO. The taxpayer-funded plan, which was only announced two weeks ago and is being justified inside the White House and the health department as a test of the Medicare program, is being driven by Centers for Medicare and Medicaid Services Administrator Seema Verma and White House chief of staff Mark Meadows, the officials said. The administration is seeking to finalize the plan as soon as Friday and send letters to 39 million Medicare beneficiaries next week, informing seniors of Trump’s new effort to lower their drug costs, although many seniors would not receive the actual cards until after the election. The $200 cards — which would resemble credit cards, would need to be used at pharmacies and could be branded with a reference to Trump himself — would be paid for by tapping Medicare’s trust fund.” [Politico, 10/8/20]
An Additional $19 Million Would Be Spent On Letters That Could Be Signed By Trump. According to Politico, “The taxpayer-funded plan would cost $7.9 billion, including about $51 million to create and distribute the cards, and it would allow seniors to use the cards to help cover a portion of their out-of-pocket expenses for up to two years. The government would also spend $19 million sending letters to seniors this month that tout the plan, according to the draft proposal. Officials are still discussing whether that letter will come from Trump himself, said two officials.” [Politico, 10/8/20]
The Cards Never Got Sent. According to Politico, “The White House will not be able to make good on President Donald Trump’s campaign promise to give older Americans discount cards to use for medicine, said four officials with knowledge of the deliberations, citing time pressures and still-unfinished planning. ‘It would take days to get all the sign-offs we still need, plus the time to print the letters and make the cards,’ said one official involved in the process, who spoke on condition of anonymity and noted that Inauguration Day is now three business days away. ‘We ran out of time.’” [Politico, 1/13/21]