Medicare Beneficiary Costs Set To Rise For Part D Drug Benefit In 2010: Fill & Download for Free

There is not much of a health plan that can become a replacement for the Patient Protection and Affordable Care Act of 2010, AKA Obamacare. It is likely to leave with no health care plan, just a patchwork of some Executive Orders that may still be applicable without the supporting PPACA in place, and lot of directives that have little force of law.The PPACA has provision for adults up to 26 years to be included on a parent’s healthcare plan, there is protection from being refused claims based on pre-existing conditions, there is a lifetime and annual maximum on out-of-pocket expenses, there are some states that have availed themselves to expand access to Medicare, there are tax rebate subsidies to support low-paid workers access to commercial and comprehensive health insurance plans if an employer does not offer anything, and some standards for Health Insurers and Providers. Nothing negative in the package, except that it is complex. There are 906 pages of detailed provisions across a range of Health Care issues. https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdfTrump’s healthcare is a an ‘ask’ for Pharmaceutical Companies to lower drug prices, make available cheap and cut-down Insurance Plans, provide some guarantees for Medicaid recipients with a lowest -price drug option, and removed the individual mandate tax penalty, weakening the participation in health care insurance. What is called a ‘Plan’ is just a list of initiatives that do not all have the weight and validity as a provision in a law, and will have no obligation to be followed - in this 8-page summary: https://www.govinfo.gov/content/pkg/FR-2020-10-01/pdf/2020-21914.pdfAs a plan, it is bankrupt, like its author. It merely summarizes positions, and does not wrap up an approach to Healthcare for all Americans, except for the assumption that if you are poor, you can die, and if you are rich, and might need to have coverage, their are a range of options now for you. If you are old, there is some Federal Support from what you have already paid for in Medicaid contributions, but do not hold out that it would last if you are not already on it now. Better that you read and understand that the emperor has no clothes, hence he stormed out of the 60 minutes meeting with Leslie Stahl as he does not understand what a Political. Government, or Legislative plan should entail.An America-First Healthcare PlanSection 1. Purpose. Since January 20, 2017, my Administration has beencommitted to the goal of bringing great healthcare to the American peopleand putting patients first. To that end, my Administration has taken monumental steps to improve the efficiency and quality of healthcare in theUnited States.(a) My Administration has been committed to restoring choice and controlto the American patient.On December 22, 2017, I signed into law the repeal of the burdensomeindividual-mandate penalty, liberating millions of low-income Americansfrom a tax that penalized them for not purchasing health-insurance coveragethey did not want or could not afford. Through Executive Order 13813of October 12, 2017 (Promoting Healthcare Choice and Competition Acrossthe United States), my Administration has expanded coverage options formillions of Americans in several ways. My Administration increased theavailability of renewable short-term, limited-duration healthcare plans, providing options that are up to 60 percent cheaper than the least expensivealternatives under the Patient Protection and Affordable Care Act (ACA)and are projected to cover 500,000 individuals who would otherwise beuninsured. My Administration expanded health reimbursement arrangements,which have been projected by the Department of the Treasury to reach800,000 businesses and over 11 million employees and to expand coverageto more than 800,000 individuals who would otherwise be uninsured. MyAdministration also issued a rule to increase the availability of associationhealth plans for small businesses, which, upon implementation of the rule,are projected to cover up to 400,000 previously uninsured individuals foron average 30 percent less cost.As set forth in the Economic Report of the President (February 2020), myAdministration’s expansion of health savings accounts will further helpmillions of Americans pay for health expenditures by allowing them tosave more of their own money free from Federal taxation, and will especiallyhelp Americans with chronic conditions who now have more flexibilityto enroll in plans that fit their complicated care needs and can be pairedwith a tax-advantaged account.At the beginning of the current COVID–19 pandemic, my Administrationacted to dramatically increase the accessibility and availability of telehealthservices for Medicare beneficiaries, enabling millions of individuals to usethese services. Pursuant to Executive Order 13941 of August 3, 2020 (Improving Rural Health and Telehealth Access), the Secretary of Health and HumanServices will make permanent many of the new policies that improve theaccessibility and availability of telehealth services. In addition, pursuantto that order, the Secretary of Health and Human Services and the Secretaryof Agriculture will develop and implement a strategy to improve the physicaland communications healthcare infrastructure available to rural Americans.Through our State Relief and Empowerment Waivers, my Administrationhas given States additional health-insurance flexibility, which has expandedhealth-insurance coverage options for consumers and lowered costs for patients. These waivers allow States to move away from the ACA’s rigidVerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00003 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORD62180 Federal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential Documentsstructure and are estimated to have lowered premiums by approximately11 percent in Wisconsin, 20 percent in Minnesota, and 43 percent in Maryland. Due to actions my Administration took, like the State Relief andEmpowerment Waivers, after years of dwindling choices and escalatingprices, plan options for consumers increased and for 2019, for the firsttime ever, benchmark premiums actually decreased on Get 2020 health coverage. Health Insurance Marketplace. For2020, the average benchmark premium dropped by nearly 4 percent.After the prior Administration spent tens of billions of dollars creatingelectronic health records systems unable to accurately or effectively recordand communicate patient data, my Administration has paved the way fora new wave of innovation to allow patients to safely send their own medicalrecords to care providers of their choosing. My Patients over Paperworkinitiative has cut red tape for doctors and nurses so they can spend moretime with their patients, which the Centers for Medicare and MedicaidServices (CMS) within the Department of Health and Human Services (HHS)has estimated to save over 40 million hours of wasted time for providersand suppliers between 2017 and 2021.(b) My Administration has been ceaseless in its efforts to lower coststo make healthcare more affordable for American patients.Under my tenure, prescription drugs saw their largest annual price decreasein nearly half a century. For three consecutive years, we have approveda record number of generic drugs. The Council of Economic Advisers hasestimated that these approvals saved patients $26 billion in the first 18months of my Administration alone. As part of the Further ConsolidatedAppropriations Act, 2020, I signed into law the Creating and RestoringEqual Access to Equivalent Samples Act, which will pave the way foreven more generic drugs and is projected to save taxpayers $3.3 billionfrom 2019 to 2029.CMS has acted to offer Medicare beneficiaries prescription drug plans withthe option of insulin capped at $35 in out-of-pocket expenses for a 30-day supply. We are also reducing Government payments to overcharginghospitals participating in the 340B Drug Pricing Program by instead payingrates that more accurately reflect the hospitals’ acquisition costs, whichCMS estimated would save Medicare beneficiaries $320 million on copayments for drugs alone.As a result of Executive Order 13937 of July 24, 2020 (Access to AffordableLife-Saving Medications), low-income Americans who receive care from afederally qualified health center will have access to insulin and injectableepinephrine at prices lower than ever before. Under Executive Order 13938of July 24, 2020 (Increasing Drug Importation to Lower Prices for AmericanPatients), my Administration will be the first to complete a rulemakingto authorize the safe importation of certain lower-cost prescription drugsfrom Canada. Pursuant to Executive Order 13939 of July 24, 2020 (LoweringPrices for Patients by Eliminating Kickbacks to Middlemen), my Administration is taking action to eliminate wasteful payments to middlemen by passingdrug discounts through to patients at the pharmacy counter without increasing premiums for beneficiaries or cost to Federal taxpayers. And my Administration is taking action to ensure that Medicare patients receive the lowestprice that drug companies offer comparable foreign nations through ExecutiveOrder 13948 of September 13, 2020 (Lowering Drug Prices by Putting AmericaFirst).As part of the Further Consolidated Appropriations Act, 2020, I also signedinto law the repeal of the medical device tax, the annual fee on healthinsurance providers, and the ‘‘Cadillac’’ tax on certain employer-sponsoredhealth insurance, which threatened to dramatically increase the cost ofhealthcare for working families.My Administration is transforming the black-box hospital and insurancepricing systems to be transparent about price and quality. Regardless ofhealth-insurance coverage, two-thirds of adults in America still worry aboutthe threat of unexpected medical bills. This fear is the result of a systemVerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00004 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORDFederal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential Documents 62181under which individuals and employers are unable to see how insurancecompanies, pharmacy benefit managers, insurance brokers, and providersare or will be paid. One major culprit is the practice of ‘‘surprise billing,’’in which a patient receives unexpected bills at highly inflated prices fromproviders who are not part of the patient’s insurance network, even ifthe patient was treated at a hospital that was part of the patient’s network.Patients can receive these bills despite having no opportunity to selectaround an out-of-network provider in advance.On May 9, 2019, I announced four principles to guide congressional effortsto prohibit exorbitant bills resulting from patients’ accidentally or unknowingly receiving services from out-of-network physicians. Unfortunately, theCongress has failed to act, and patients remain vulnerable to surprise billing.In the absence of congressional action, my Administration has already takenstrong and decisive action to make healthcare prices more transparent. OnJune 24, 2019, I signed Executive Order 13877 (Improving Price and QualityTransparency in American Healthcare to Put Patients First), directing certainagencies—for the first time ever—to make sure patients have access to meaningful price and quality information prior to the delivery of care. BeginningJanuary 1, 2021, hospitals will be required to publish their real price forevery service, and publicly display in a consumer-friendly, easy-to-understand format the prices of at least 300 different common services that areable to be shopped for in advance.We have also taken some concrete steps to eliminate surprise out-of-networkbills. For example, on April 10, 2020, my Administration required providersto certify, as a condition of receiving supplemental COVID–19 funding,that they would not seek to collect out-of-pocket expenses from a patientfor treatment related to COVID–19 in an amount greater than what thepatient would have otherwise been required to pay for care by an innetwork provider. These initiatives have made important progress, althoughadditional efforts are necessary.Not all hospitals allow for surprise bills. But many do. Unfortunately, surprisebilling has become sufficiently pervasive that the fear of receiving a surprisebill may dissuade patients from seeking appropriate care. And researchsuggests a correlation between hospitals that frequently allow surprise billingand increases in hospital admissions and imaging procedures, putting patients at risk of receiving unnecessary services, which can lead to physicalharm and threatens the long-term financial sustainability of Medicare.Efforts to limit surprise billing and increase the number of providers participating in the same insurance network as the hospital in which they workwould correspondingly streamline the ability of patients to receive careand reduce time spent on billing disputes.On May 15, 2020, HHS released the Health Quality Roadmap to empowerpatients to make fully informed decisions about their healthcare by facilitating the availability of appropriate and meaningful price and quality information. These transformative actions will arm patients with the tools tobe active and effective shoppers for healthcare services, enabling them toidentify high-value providers and services, and ultimately place downwardpressure on prices.My Administration has cracked down on waste, fraud, and abuse that directvaluable taxpayer resources away from those who need them most. MyAdministration implemented a ‘‘site neutral’’ payment system between hospital outpatient departments and physicians’ offices, to ensure Medicarebeneficiaries are charged the same price for the same service regardlessof where it takes place, which CMS estimates will save them approximately$160 million in co-payments for 2020. We also changed the rules to enableGovernment watchdogs to proactively identify and stop perpetrators of fraudbefore money goes out the door.(c) My Administration has been dedicated to providing better care forall Americans.VerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00005 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORD62182 Federal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential DocumentsThis includes a steadfast commitment to always protecting individuals withpre-existing conditions and ensuring they have access to the high-qualityhealthcare they deserve. No American should have to risk going withouthealth insurance based on a health history that he or she cannot change.In an attempt to justify the ACA, the previous Administration claimedthat, absent action by the Congress, up to 129 million (later updated to133 million) non-elderly people with what it described as pre-existing conditions were in danger of being denied health-insurance coverage. Accordingto the previous Administration, however, only 2.7 percent of such individualsactually gained access to health insurance through the ACA, given existinglaws and programs already in place to cover them. For example, the HealthInsurance Portability and Accountability Act of 1996 has long protectedindividuals with pre-existing conditions, including individuals covered bygroup health plans and individuals who had such coverage but lost it.The ACA produced multiple other failures. The average insurance premiumin the individual market more than doubled from 2013 to 2017, and thosewho have not received generous Federal subsidies have struggled to maintaincoverage. For those who have managed to maintain coverage, many haveexperienced a substantial rise in deductibles, limited choice of insurers,and limited provider networks that exclude their doctors and the facilitiesbest suited to care for them.Additionally, approximately 30 million Americans remain uninsured, notwithstanding the previous Administration’s promises that the ACA wouldaddress this intractable problem. On top of these disappointing results,Federal taxpayers and, unfortunately, future generations of American workers,have been left with an enormous bill. The ACA’s Medicaid expansion andsubsidies for the individual market are projected by the Congressional BudgetOffice to cost more than $1.8 trillion over the next decade.The ACA is neither the best nor the only way to ensure that Americanswho suffer from pre-existing conditions have access to health-insurancecoverage. I have agreed with the States challenging the ACA, who havewon in the Federal district court and court of appeals, that the ACA, asamended, exceeds the power of the Congress. The ACA was flawed fromits inception and should be struck down. However, access to health insurancedespite underlying health conditions should be maintained, even if theSupreme Court invalidates the unconstitutional, and largely harmful, ACA.My Administration has always been committed to ensuring that patientswith pre-existing conditions can obtain affordable healthcare, to loweringhealthcare costs, to improving quality of care, and to enabling individualsto choose the healthcare that meets their needs. For example, when theCOVID–19 pandemic hit, my Administration implemented a program toprovide any individual without health-insurance coverage access to necessaryCOVID–19-related testing and treatment.My commitment to improving care across our country expands vastly beyondthe rules governing health insurance. On July 10, 2019, I signed ExecutiveOrder 13879 (Advancing American Kidney Health) to improve care for thehundreds of thousands of Americans suffering from end-stage renal disease.Pursuant to that order, my Administration launched a program to encouragehome dialysis and promote transplants for patients, and expects to enrollapproximately 120,000 Medicare beneficiaries with end-stage renal diseasein the program. We also have removed financial barriers to living organdonation by adding additional financial support for living donors, suchas by reimbursing expenses for lost wages, child care, and elder care. HHS,together with the American Society of Nephrology, issued two phases ofawards through KidneyX’s Redesign Dialysis Price Competition to worktoward the creation of an artificial kidney.My Administration has taken unprecedented action to improve the qualityof and access to care for individuals with HIV, as part of our goal ofending the epidemic of HIV in the United States by 2030. HHS has awardedVerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00006 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORDFederal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential Documents 62183at least $226 million to expand access to HIV care, treatment, medication,and prevention services, focused on 48 counties, Washington, DC, and SanJuan, Puerto Rico, where more than 50 percent of new HIV diagnoses occurredin 2016 and 2017, as well as seven States with a substantial rural HIVrate. We secured a historic donation of a groundbreaking HIV preventivemedication that is available at no cost to eligible patients.My Administration has started a transformation in healthcare in rural America. This includes a new effort, pursuant to my directive in Executive Order13941, to support small hospitals and health clinics in rural communitiesin transitioning from volume-based Medicare and Medicaid reimbursement,which has failed rural communities that struggle with a lack of patientvolume, and toward value-based payment mechanisms that are tailored tomeet the needs of their communities. We updated Medicare payment policiesto address a problem in the program’s payment calculation that has historically disadvantaged rural hospitals, and released a Rural Action Plan toincorporate recommendations from experts and leaders across the FederalGovernment. We have also dedicated a special focus on improving careoffered through the Indian Health Service (IHS) within HHS, including bycreating the Office of Quality, implementing an increase in annual fundingfor IHS by $243 million from 2019 to 2020, and expanding nationwideIHS’s successful Alaska Community Health Aide Program.My Administration has additionally demonstrated an incredible dedicationto protecting and improving care for those most in need, including seniorcitizens, those with substance use disorders, and those to whom our Nationowes the greatest debt: our veterans.I have protected the viability of the Medicare program. For example, onFebruary 9, 2018, I signed into law the repeal of the Independent PaymentAdvisory Board, which would have been a group of unelected bureaucratscreated by the ACA, designed to be insulated from the will of America’selected leaders for the purpose of cutting the spending of this importantprogram. On October 3, 2019, I signed Executive Order 13890 (Protectingand Improving Medicare for Our Nation’s Seniors), to modernize the Medicareprogram and continue its viability. According to CMS estimates, seniorshave saved $2.65 billion in lower Medicare premiums under my Administration while benefiting from more choices. For example, the average monthlyMedicare Advantage premium has declined an estimated 28 percent since2017, and Medicare Advantage has included about 1,200 more plan optionssince 2018. New Medicare Advantage supplemental benefits have helpedseniors stay safe in their homes, improved respite care for caregivers, andprovided transportation, more in-home support services and assistance, andnon-opioid pain management alternatives like therapeutic massages. MedicarePart D premiums are at their lowest level in their history, with the averagebasic premium declining 13.5 percent since 2016.My Administration has directed unprecedented attention on the substanceuse disorder epidemic, with a focus on reducing overdose deaths fromprescription opioids and the deadly synthetic opioid fentanyl. On October24, 2018, I signed the Substance Use-Disorder Prevention that PromotesOpioid Recovery and Treatment for Patients and Communities Act, enablingthe expenditure of billions of dollars of funding for important programsto support prevention and recovery. My Administration has provided approximately $22.5 billion from 2017 to 2020 to address the opioid crisisand improve access to prevention, treatment, and recovery services. Wesaw a 34 percent decrease in total opioids dispensed monthly by pharmaciesbetween 2017 and 2019, an approximate increase of 64 percent in thenumber of Americans who receive medication-assisted treatment for opioiduse disorder since 2016, and a 484 percent increase in naloxone prescriptionssince 2017. Data show that drug overdose deaths fell nationwide for thefirst time in decades between 2017 and 2018, with many of the hardesthit States leading the way.VerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00007 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORD62184 Federal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential DocumentsImproving care for our Nation’s veterans has been a priority since the beginning of my Administration. On June 6, 2018, I signed the VA MaintainingInternal Systems and Strengthening Integrated Outside Networks (MISSION)Act of 2018, which authorized billions of dollars to improve options forveterans to receive care outside of Department of Veterans Affairs (VA)healthcare providers. Since taking effect, the VA estimates that more than2.4 million veterans have benefited from more than 6.5 million referralsto the 725,000 private healthcare providers with which the VA is nowworking. On June 23, 2017, I signed the Department of Veterans AffairsAccountability and Whistleblower Protection Act of 2017 to hold our civilservants accountable for maintaining the best quality of care possible forour Nation’s veterans by giving the Secretary of Veterans Affairs more powerto discipline employees and shorten an appeals process that can last years.On March 5, 2019, I signed Executive Order 13861 (National Roadmapto Empower Veterans and End Suicide) to ensure that the Federal Governmentleads a collective effort to prevent suicide among our veterans.I have used scientific research to focus on areas most pressing for thehealth of Americans. On September 19, 2019, I signed Executive Order13887 (Modernizing Influenza Vaccines in the United States to PromoteNational Security and Public Health), recognizing the threat that pandemicinfluenza continues to represent and putting forward a plan to preparefor future influenza pandemics. To modernize influenza vaccines and promote national security and public health, HHS issued a 6-year, $226 millioncontract to retain and increase capacity to produce recombinant influenzavaccine domestically, and the National Institute of Allergy and InfectiousDiseases, part of the National Institutes of Health within HHS, initiatedthe Collaborative Influenza Vaccine Innovation Centers program.Investments my Administration has made in scientific research will helptackle some of our most pressing medical challenges and pay dividendsfor generations to come. This includes working to increase funding forAlzheimer’s disease research by billions of dollars since 2017 and a planto invest more than $500 million over the next decade to improve pediatriccancer research. On December 18, 2018, I signed the Sickle Cell Diseaseand Other Heritable Blood Disorders Research, Surveillance, Prevention,and Treatment Act of 2018 to provide support for research into sicklecell disease, which disproportionately impacts African Americans and Hispanics, and to authorize programs relating to sickle cell disease surveillance,prevention, and treatment.On May 30, 2018, I signed the Trickett Wendler, Frank Mongiello, JordanMcLinn, and Matthew Bellina Right to Try Act of 2017, which gives terminally ill patients the right to access certain treatments without being blockedby onerous Federal regulations.In response to the COVID–19 pandemic, my Administration launched Operation Warp Speed, a groundbreaking effort of the Federal Government toengage with the private sector to quickly develop and deliver safe andeffective vaccines, therapeutics, and diagnostics for COVID–19. On August6, 2020, I signed Executive Order 13944 (Combating Public Health Emergencies and Strengthening National Security by Ensuring Essential Medicines,Medical Countermeasures, and Critical Inputs Are Made in the United States),to protect Americans through reduced dependence on foreign manufacturersfor essential medicines and other items and to strengthen the Nation’s PublicHealth Industrial Base.Taken together, these extraordinary reforms constitute an ongoing effort toimprove American healthcare by putting patients first and delivering continuous innovation. And this effort will continue to succeed because of myAdministration’s commitment to delivering great healthcare with morechoices, better care, and lower costs for all Americans.Sec. 2. Policy. It has been and will continue to be the policy of the UnitedStates to give Americans seeking healthcare more choice, lower costs, andVerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00008 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORDFederal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential Documents 62185better care and to ensure that Americans with pre-existing conditions canobtain the insurance of their choice at affordable rates.Sec. 3. Giving Americans More Choice in Healthcare. The Secretary of theTreasury, the Secretary of Labor, and the Secretary of Health and HumanServices shall maintain and build upon existing actions to expand accessto and options for affordable healthcare.Sec. 4. Lowering Healthcare Costs for Americans. (a) The Secretary of Healthand Human Services, in coordination with the Commissioner of Food andDrugs, shall maintain and build upon existing actions to expand accessto affordable medicines, including accelerating the approvals of new genericand biosimilar drugs and facilitating the safe importation of affordable prescription drugs from abroad.(b) The Secretary of the Treasury, the Secretary of Labor, and the Secretaryof Health and Human Services shall maintain and build upon existing actionsto ensure consumers have access to meaningful price and quality informationprior to the delivery of care.(i) Recognizing that both chambers of the Congress have made substantialprogress towards a solution to end surprise billing, the Secretary of Healthand Human Services shall work with the Congress to reach a legislativesolution by December 31, 2020.(ii) In the event a legislative solution is not reached by December 31,2020, the Secretary of Health and Human Services shall take administrativeaction to prevent a patient from receiving a bill for out-of-pocket expensesthat the patient could not have reasonably foreseen.(iii) Within 180 days of the date of this order, the Secretary of Healthand Human Services shall update the Medicare.gov: the official U.S. government site for Medicare Hospital Comparewebsite to inform beneficiaries of hospital billing quality, including:(A) whether the hospital is in compliance with the Hospital Price Transparency Final Rule, as amended (84 Fed. Reg. 65524), effective January1, 2021;(B) whether, upon discharge, the hospital provides patients with a receiptthat includes a list of itemized services received during a hospital stay;and(C) how often the hospital pursues legal action against patients, includingto garnish wages, to place a lien on a patient’s home, or to withdrawmoney from a patient’s income tax refund.(c) The Secretary of Health and Human Services, in coordination withthe Administrator of CMS, shall maintain and build upon existing actionsto reduce waste, fraud, and abuse in the healthcare system.Sec. 5. Providing Better Care to Americans. (a) The Secretary of Healthand Human Services and the Secretary of Veterans Affairs shall maintainand build upon existing actions to improve quality in the delivery of carefor veterans.(b) The Secretary of Health and Human Services shall continue to promotemedical innovations to find novel and improved treatments for COVID–19, Alzheimer’s disease, sickle cell disease, pediatric cancer, and other conditions threatening the well-being of Americans.Sec. 6. General Provisions. (a) Nothing in this order shall be construedto impair or otherwise affect:(i) the authority granted by law to an executive department or agency,or the head thereof; or(ii) the functions of the Director of the Office of Management and Budgetrelating to budgetary, administrative, or legislative proposals.(b) This order shall be implemented consistent with applicable law andsubject to the availability of appropriations.VerDate Sep<11>2014 21:36 Sep 30, 2020 Jkt 253001 PO 00000 Frm 00009 Fmt 4705 Sfmt 4790 E:\FR\FM\01OCE0.SGM 01OCE0jbell on DSKJLSW7X2PROD with EXECORD62186 Federal Register / Vol. 85, No. 191 / Thursday, October 1, 2020 / Presidential Documents(c) This order is not intended to, and does not, create any right or benefit,substantive or procedural, enforceable at law or in equity by any partyagainst the United States, its departments, agencies, or entities, its officers,employees, or agents, or any other person.

It’s not health care it’s robbery off disease care''You need to understand that they want you sick and dying, expensively.'' Carolyn DeanI could go on but it’s all on WHALE and summed up nicely, the money side, below, and that’s just the tip of the drug racket iceberg50 Signs That The U.S. Health Care System Is A Gigantic Money Making ScamBy Michael, on February 24th, 2013 http://theeconomiccollapseblog.comThe U.S. health care system is a giant money making scam that is designed to drain as much money as possible out of all of us before we die. In the United States today, the health care industry is completely dominated by government bureaucrats, health insurance companies and pharmaceutical corporations. The pharmaceutical corporations spend billions of dollars to convince all of us to become dependent on their legal drugs, the health insurance companies make billions of dollars by providing as little health care as possible, and they both spend millions of dollars to make sure that our politicians in Washington D.C. keep the gravy train rolling. Meanwhile, large numbers of doctors are going broke and patients are not getting the care that they need. At this point, our health care system is a complete and total disaster. Health care costs continue to go up rapidly, the level of care that we are receiving continues to go down, and every move that our politicians make just seems to make all of our health care problems even worse. In America today, a single trip to the emergency room can easily cost you $100,000, and if you happen to get cancer you could end up with medical bills in excess of a million dollars. Even if you do have health insurance, there are usually limits on your coverage, and the truth is that just a single major illness is often enough to push most American families into bankruptcy. At the same time, hospital administrators, pharmaceutical corporations and health insurance company executives are absolutely swimming in huge mountains of cash. Unfortunately, this gigantic money making scam has become so large that it threatens to collapse both the U.S. health care system and the entire U.S. economy.The following are 50 signs that the U.S. health care system is a massive money making scam that is about to collapse...#1 Medical bills have become so ridiculously large that virtually nobody can afford them. Just check out the following short excerpt from a recent Time Magazine article. One man in California that had been diagnosed with cancer ran up nearly a million dollars in hospital bills before he died...By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece. There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work.#2 This year the American people will spend approximately 2.8 trillion dollars on health care, and it is being projected that Americans will spend 4.5 trillion dollars on health care in 2019.#3 The United States spends more on health care than Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia combined.#4 If the U.S. health care system was a country, it would be the 6th largest economy on the entire planet.#5 Back in 1960, an average of $147 was spent per person on health care in the United States. By 2009, that number had skyrocketed to $8,086.#6 Why does it cost so much to stay in a hospital today? It just does not make sense. Just check outthese numbers...In 1942, Christ Hospital, NJ charged $7 per day for a maternity room. Today it’s $1,360.#7 Approximately 60 percent of all personal bankruptcies in the United States are related to medical bills.#8 One study discovered that approximately 41 percent of all working age Americans either have medical bill problems or are currently paying off medical debt.#9 The U.S. health care industry has spent more than 5 billion dollars on lobbying our politicians in Washington D.C. since 1998.#10 According to the Association of American Medical Colleges, the U.S. is currently experiencing a shortage of at least 13,000 doctors. Unfortunately, that shortage is expected to growto 130,000 doctors over the next 10 years.#11 The state of Florida is already dealing with a very serious shortage of doctors...Brace yourself for longer lines at the doctor's office.Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse.#12 At this point, approximately 40 percent of all doctors in the United States are 55 years of age or older.#13 In America today, many hospital executives make absolutely ridiculous amounts of money...In December, when the New York Times ran a story about how a deficit deal might threaten hospital payments, Steven Safyer, chief executive of Montefiore Medical Center, a large nonprofit hospital system in the Bronx, complained, “There is no such thing as a cut to a provider that isn’t a cut to a beneficiary … This is not crying wolf.”Actually, Safyer seems to be crying wolf to the tune of about $196.8 million, according to the hospital’s latest publicly available tax return. That was his hospital’s operating profit, according to its 2010 return. With $2.586 billion in revenue — of which 99.4% came from patient bills and 0.6% from fundraising events and other charitable contributions — Safyer’s business is more than six times as large as that of the Bronx’s most famous enterprise, the New York Yankees. Surely, without cutting services to beneficiaries, Safyer could cut what have to be some of the Bronx’s better non-Yankee salaries: his own, which was $4,065,000, or those of his chief financial officer ($3,243,000), his executive vice president ($2,220,000) or the head of his dental department ($1,798,000).#14 Health insurance administration expenses account for 8 percent of all health care costs in the United States each year. In Finland, health insurance administration expenses account for just 2 percent of all health care costs each year.#15 If you can believe it, the U.S. ambulance industry makes more money each year than the movie industry does.#16 All over America, people are reporting huge health insurance premium increases thanks to Obamacare. The following example is from a recent article by Robert Wenzel...A California small businessman tells me that he switched healthcare insurance carriers in 2012. The monthly premium for him and his wife was about $400, but when he received his first bill in January of this year it was for $1,200. He hasn't been to a doctor in years, his wife has only gone for minor care.Apparently there is some clause in the Affordable Healthcare Act that results in health insurance firms using a new method to calculate premiums. Those who have health insurance plans that have been in effect since at least 2010 are grandfathered under the old calculation method, but insurance carriers are using a new formula for new plans.#17 Blue Shield of California has announced that it wants to raise health insurance premiums by up to 20 percent this year in an effort to keep up with rising health costs.#18 Aetna's CEO says that health insurance premiums for many Americans will double when the major provisions of Obamacare go into effect in 2014.#19 Close to 10 percent of all U.S. employers plan to drop health coverage completely when the major provisions of Obamacare go into effect in 2014.#20 According to a survey conducted by the Doctor Patient Medical Association, 83 percent of all doctors in the United States have considered leaving the profession because of Obamacare.#21 Approximately 16,000 new IRS agents will be hired to help oversee the implementation of Obamacare, and the Obama administration has given the IRS 500 million extra dollars "outside the normal appropriations process" to help the IRS with their new duties.#22 During 2013, Americans will spend more than 280 billion dollars on prescription drugs.#23 Prescription drugs cost about 50% more in the United States than they do in other countries.#24 In the United States today, prescription painkillers kill more Americans than heroin and cocaine combined.#25 Nearly half of all Americans now use prescription drugs on a regular basis according to the CDC. Not only that, the CDC also says that approximately one-third of all Americans use two or more pharmaceutical drugs on a regular basis, and more than ten percent of all Americans use five or more pharmaceutical drugs on a regular basis.#26 The percentage of women taking antidepressants in America is higher than in any other country in the world.#27 In 2010, the average teen in the U.S. was taking 1.2 central nervous system drugs. Those are the kinds of drugs which treat conditions such as ADHD and depression.#28 Children in the United States are three times more likely to be prescribed antidepressants as children in Europe are.#29 There were more than two dozen pharmaceutical companies that made over a billion dollars in profits during 2008.#30 According to the CDC, approximately three quarters of a million people a year are rushed to emergency rooms in the United States because of adverse reactions to pharmaceutical drugs.#31 According to a report by Health Care for America Now, America's five biggest for-profit health insurance companies ended 2009 with a combined profit of $12.2 billion.#32 The top executives at the five largest for-profit health insurance companies in the United States combined to bring in nearly $200 million in total compensation for 2009.#33 The chairman of Aetna, the third largest health insurance company in the United States, brought in a staggering $68.7 million during 2010. Ron Williams exercised stock options that were worth approximately $50.3 million and he raked in an additional $18.4 million in wages and other forms of compensation. The funny thing is that he left the company and didn’t even work the entire year.#34 It turns out that the financial assistance that Barack Obama promised would be provided for those with "pre-existing conditions" under Obamacare is already being shut down because of a lack of funding...Tens of thousands of Americans who cannot get health insurance because of preexisting medical problems will be blocked from a program designed to help them because funding is running low.Obama administration officials said Friday that the state-based “high-risk pools” set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state.#35 In America today, you are 64 times more likely to be killed by a doctor than you are by a gun.#36 People living in the United States are three times more likely to have diabetes than people living in the United Kingdom.#37 Today, people living in Puerto Rico have a greater life expectancy than people living in the United States do.#38 According to OECD statistics, Americans are twice as obese as Canadians are.#39 Greece has twice as many hospital beds per person as the United States does.#40 The state of California now ranks dead last out of all 50 states in the number of emergency rooms per million people.#41 According to a doctor interviewed by Fox News, "a gunshot wound to the head, chest or abdomen" will cost $13,000 at his hospital the moment the victim comes in the door, and then there will be significant additional charges depending on how bad the wound is.#42 It has been estimated that hospitals overcharge Americans by about 10 billion dollars every single year.#43 One trained medical billing advocate says that over 90 percent of the medical bills that she has audited contain "gross overcharges".#44 It is not uncommon for insurance companies to get hospitals to knock their bills down by up to 95 percent, but if you are uninsured or you don’t know how the system works then you are out of luck.#45 According to a study conducted by Deloitte Consulting, a whopping 875,000 Americans were "medical tourists" in 2010.#46 Today, there are more than 56 million Americans on Medicaid, and it is being projected that Obamacare will add 16 million more Americans to the Medicaid rolls.#47 Back in 1965, only one out of every 50 Americans was on Medicaid. Today, one out of every 6Americans is on Medicaid.#48 Today, there are more than 50 million Americans on Medicare, and that number is projected to grow to 73.2 million in 2025.#49 When Medicare was first established by Congress, it was estimated that it would cost the federal government $12 billion a year by the time 1990 rolled around. Instead, it cost the federal government $110 billion in 1990, and it will cost the federal government close to $600 billion this year.#50 Even if you do have health insurance, that is no guarantee that medical bills will not bankrupt you. Just check out what a recent Time Magazine article says happened to one unfortunate couple from Ohio that actually did have health insurance...When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance.By the way, that hospital down in Houston made a profit of 531 million dollars in one recent year.So what can be done about all of this?Well, the truth is that the status quo is a complete and total disaster, and every "solution" being promoted by politicians from both major political parties would only make things worse.In the end, the U.S. health care system needs to be rebuilt from the ground up, but we all know that is not going to happen.Instead, our politicians and the health care industry will just find additional ways to extract money from all of us, and the level of care that we all get will continue to decline.If you don't believe this, just check out what Paul Krugman of the New York Times had to say recently...We’re going to need more revenue…Surely it will require some sort of middle class taxes as well.. We won’t be able to pay for the kind of government the society will want without some increase in taxes… on the middle class, maybe a value added tax…And we’re also going to have to make decisions about health care, doc pay for health care that has no demonstrated medical benefits . So the snarky version…which I shouldn’t even say because it will get me in trouble is death panels and sales taxes is how we do this.Others are urging us to become more like Europe.But do we really want what they have in the UK?...Sick children are being discharged from NHS hospitals to die at home or in hospices on controversial ‘death pathways’.Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults.But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone.Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a baby becomes ‘smaller and shrunken’.In the end, my philosophy is just to avoid the U.S. health care system as much as possible. Most doctors are just trained to do two things - prescribe drugs and cut you open. In an emergency situation where you are about to die, those may be your best options, but otherwise I would just as soon avoid the gigantic money making scam that the U.S. health care industry has become.

This answer is long. The New York Times recently fact checked the alleged achievements of Donald Trump’s term. While they make excuses and try to spin achievements, the first word of each answer is what counts. I won’t give it away. Read it for yourself.By Farah StockmanMs. Stockman is a member of the editorial board.Sept. 11, 20201. Trump recently signed 3 bills to benefit Native people. One gives compensation to the Spokane tribe for loss of their lands in the mid-1900s, one funds Native language programs, and the third gives federal recognition to the Little Shell Tribe of Chippewa Indians in Montana.True, but tribal leaders credit bipartisan efforts in Congress for those bills. In 2019, Mr. Trump signed the Spokane Reservation Equitable Compensation Act for the loss of land that was flooded by the Grand Coulee Dam. Interior Secretary Ryan Zinke visited the reservation and pledged to support the bill. But Carol Evans, chairwoman of the Spokane Tribal Business Council, said most of the credit for the law goes to two members of Congress from Washington, Senator Maria Cantwell, a Democrat, and Representative Cathy McMorris Rodgers, a Republican. Mr. Trump also signed the Esther Martinez Native American Languages Programs Reauthorization Act, which revises an existing grant program. That bill was introduced by Senator Tom Udall, Democrat of New Mexico. Lastly, Mr. Trump signed the National Defense Authorization Act of 2019, which included a provision that gave long-overdue federal recognition to the Little Shell Tribe. Tribal Chairman Gerald Gray credits the bipartisan efforts of Senators Jon Tester, a Democrat, and Steve Daines, a Republican, both of Montana, for tucking the tribal recognition provision into the military spending bill.2. Trump finalized the creation of Space Force as our 6th Military branch.True. But senior military leaders publicly opposed its creation, including Mr. Trump’s secretary of defense, James Mattis, because they argued it would create further complicated bureaucracy and counteract the Air Force’s work to defend the country’s space assets.3. Trump signed a law to make cruelty to animals a federal felony so that animal abusers face tougher consequences. 👀👀True. A bipartisan group in Congress also deserves credit for the Preventing Animal Cruelty and Torture Act.Unlock more free articles.Create an account or log in4.) Violent crime has fallen every year he’s been in office after rising during the 2 years before he was elected.The violent crime rate has dropped steadily since 1999, from 523 per 100,000 inhabitants in 1999 to 432 in 2009 to 369 in 2018. The rate rose slightly in 2015 and 2016, but the general trend has been a long downward slide that predated his election.5. Trump signed a bill making CBD and Hemp legal. 👀👀True. Congress also deserves credit for the inclusion of this measure in the 2018 Farm Bill, which Mr. Trump signed.6. Trump’s EPA gave $100 million to fix the water infrastructure problem in Flint, Michigan.Both President Barack Obama and Mr. Trump deserve credit for this allocation, which was set in motion before Mr. Obama left office.Editors’ PicksMontana’s Greatest Cultural Export: Inane Campaign AdsWhy Are Men Still Explaining Things to Women?Chevy’s Little Engine That CouldContinue reading the main story7. Under Trump’s leadership, in 2018 the U.S. surpassed Russia and Saudi Arabia to become the world’s largest producer of crude oil.True. Domestic oil production has been expanding since 2010, predating the Trump administration.8. Trump signed a law ending the gag orders on Pharmacists that prevented them from sharing money-saving information.True. Mr. Trump tweeted in support of this law and deserves credit for using the bully pulpit of the presidency to demand transparency in drug prices. But Congress deserves most of the credit for the unanimous 2018 passage of this transparency law, which prohibits gag orders that prevent pharmacists from sharing prescription drug prices with customers.9. Trump signed the “Allow States and Victims to Fight Online Sex Trafficking Act” (FOSTA), which includes the “Stop Enabling Sex Traffickers Act” (SESTA) which both give law enforcement and victims new tools to fight sex trafficking. 👀👀True. The bill was crafted and pushed through Congress by Representative Ann Wagner, a conservative Republican from Missouri, who thanked Ivanka Trump for advocating its passage.10. Trump signed a bill to require airports to provide spaces for breastfeeding Moms.True. Congress also deserves credit for the Friendly Airports for Mothers Act of 2017, which was championed by Senator Tammy Duckworth, Democrat of Illinois, and former Representative Stephen Knight, Republican of California.11. The 25% lowest-paid Americans enjoyed a 4.5% income boost in November 2019, which outpaces a 2.9% gain in earnings for the country’s highest-paid workers.Probably true. Before the pandemic struck, low-wage workers saw wage increases.12. Low-wage workers are benefiting from higher minimum wages and from corporations that are increasing entry-level pay.It is grossly misleading to claim this as a Trump accomplishment. Higher state and local minimum wages are results of state and local laws increasing the minimum wage, not federal law. Mr. Trump has flip-flopped on raising the federal minimum wage.13. Trump signed the biggest wilderness protection & conservation bill in a decade and designated 375,000 acres as protected land.This is misleading. While Mr. Trump did sign the John D. Dingell Jr. Conservation, Management and Recreation Act of 2019, he has stripped protections from far more land than he has preserved. Most notably, he removed some two million acres in Utah that had been part of the Bears Ears National Monument and the Grand Staircase-Escalante in Utah. According to a study published in May 2019 in Science, Mr. Trump is responsible for the largest reduction in the boundaries of protected land in U.S. history.14. Trump signed the Save our Seas Act which funds $10 million per year to clean tons of plastic & garbage from the ocean. 👀👀True. The credit for the passage of this legislation goes to a bipartisan group in Congress, namely Senator Dan Sullivan, a Republican from Alaska, Senator Sheldon Whitehouse, a Democrat from Rhode Island, and Senator Cory Booker, a Democrat from New Jersey.15. He signed a bill this year allowing some drug imports from Canada so that prescription prices would go down.President Trump has signed a series of executive orders aimed at making it easier for states to import cheaper drugs from Canada. But it is far from clear whether these executive orders will succeed in that aim. This proposal bears no resemblance to Mr. Trump’s 2016 promise to use the buying power of the federal government to negotiate lower prices for drugs for Medicare patients, which would save hundreds of billions of dollars over a decade. Mr. Trump has not kept that promise. If he were serious about doing so, he would push Republicans in the Senate to pass the Elijah E. Cummings Lower Drug Costs Now Act, which Democrats passed last year. There’s no evidence that he has done so.16. Trump signed an executive order this year that forces all health care providers to disclose the cost of their services so that Americans can comparison shop and know how much fewer providers charge insurance companies.True. Hospitals are now required to publicize their prices, which was also required by a little-known provision of the Affordable Care Act, signed by Mr. Obama. But enforcement has been spotty, and there has been little effort to hold hospitals to uniform standards, so it is still difficult if not impossible for consumers to compare costs, according to the journalism project Clear Health Costs.17. When signing that bill he said no American should be blindsided by bills for medical services they never agreed to in advance.Mr. Trump did say this. Unfortunately, people are still getting blindsided by medical bills.18. Hospitals will now be required to post their standard charges for services, which include the discounted price a hospital is willing to accept.See No. 16.19. In the eight years prior to President Trump’s inauguration, prescription drug prices increased by an average of 3.6% per year. Under Trump, drug prices have seen year-over-year declines in nine of the last ten months, with a 1.1% drop as of the most recent month.The data is mixed on whether drug prices are going up or down.20. He created a White House VA Hotline to help veterans and principally staffed it with veterans and direct family members of veterans. 👀👀True. Mr. Trump fulfilled this campaign promise by creating a West Virginia-based call center. It has limited powers to solve the problems of the veterans who call in from around the country.21. VA employees are being held accountable for poor performance, with more than 4,000 VA employees removed, demoted, and suspended so far.Many Department of Veterans Affairs employees have been demoted, removed or suspended during the Trump era, although there have been allegations that some of them were being punished for their political affiliations, not poor performance.22. Issued an executive order requiring the Secretaries of Defense, Homeland Security, and Veterans Affairs to submit a joint plan to provide veterans access to access to mental health treatment as they transition to civilian life.True.23. Because of a bill signed and championed by Trump, In 2020, most federal employees will see their pay increase by an average of 3.1% — the largest raise in more than 10 years.This is grossly misleading, at best. Far from being a champion of pay raises for federal workers, Mr. Trump proposed pay freezes for federal employees three years in a row; he was overridden by Congress. For 2020, Mr. Trump initially proposed a pay freeze, but then changed his proposal to a 2.6 percent increase. Congress raised that further, to 3.1 percent. Mr. Trump signed that pay raise into law when he put his signature on an omnibus budget bill, according to Jacqueline Simon, policy director of the American Federation of Government Employees.24. Trump signed into law up to 12 weeks of paid parental leave for millions of federal workers.True. Tucked into the National Defense Authorization Act was a provision that gave all federal workers 12 weeks of paid parental leave for the first time in history.25. Trump administration will provide H.I.V. prevention drugs for free to 200,000 uninsured patients per year for 11 years. 👀👀True. The drugs are being donated by Gilead, a drug-development company. But the cost of patient visits and testing are not covered, and the Trump administration opposes expanding Medicare in the Southern states where H.I.V. infection rates are rising.26. All-time record sales during the 2019 holidays.Unclear what data this item is referring to.27. Trump signed an order allowing small businesses to group together when buying insurance to get a better price👀👀True, but a federal judge struck down the plan.28. President Trump signed the Preventing Maternal Deaths Act that provides funding for states to develop maternal mortality reviews to better understand maternal complications and identify solutions & largely focuses on reducing the higher mortality rates for Black Americans.True. Congress passed this act with broad bipartisan support, including 190 co-sponsors in the House.29. In 2018, President Trump signed the groundbreaking First Step Act, a criminal justice bill that enacted reforms that make our justice system fairer and help former inmates successfully return to society.True. The Trump administration championed these reforms. Credit also goes to criminal justice reform advocates from across the political spectrum who pushed these changes for years.30. The First Step Act’s reforms addressed inequities in sentencing laws that disproportionately harmed Black Americans and reformed mandatory minimums that created unfair outcomes. 👀👀True.31. The First Step Act expanded judicial discretion in the sentencing of nonviolent crimes.True.32. Over 90% of those benefiting from the retroactive sentencing reductions in the First Step Act are Black Americans.True.33. The First Step Act provides rehabilitative programs to inmates, helping them successfully rejoin society and not return to crime.It is true that the First Step Act calls for the Bureau of Prisons to significantly expand these opportunities, but because of a lack of funding, around 25 percent of people who spend more than a year in federal prison have not completed any program, according to the Brennan Center for Justice, which backed the bill.34. Trump increased funding for Historically Black Colleges and Universities (HBCUs) by more than 14%. 👀👀Krystal L. Williams, an assistant professor at the University of Alabama College of Education who has studied federal funding of H.B.C.U.s, points to publicly available data from the Integrated Postsecondary Education Data System on this matter. The data suggest an increase of about 6 percent in federal appropriations, grants and contracts from the 2016-2017 academic year to 2017-2018, the most recent year for which such data is available.35. Trump signed legislation forgiving Hurricane Katrina debt that threatened HBCUs.True.36. New single-family home sales are up 31.6% in October 2019 compared to just one year ago.This appears to have been true at the time.37. Made HBCUs a priority by creating the position of executive director of the White House Initiative on HBCUs.True. This previously existing position was moved from the Department of Education to the White House. Experts disagree about its impact.38. Trump received the Bipartisan Justice Award at a historically black college for his criminal justice reform accomplishments.True. Students protested.39. The poverty rate fell to a 17-year low of 11.8% under the Trump administration as a result of a jobs-rich environment. 👀👀This appears to have been true, according to census data, although economists disagree on the reason for the drop.40. Poverty rates for African-Americans and Hispanic-Americans have reached their lowest levels since the U.S. began collecting such data.This was true before the coronavirus pandemic struck.41. President Trump signed a bill that creates five national monuments, expands several national parks, adds 1.3 million acres of wilderness, and permanently reauthorizes the Land and Water, Conservation Fund.See No. 13.ADVERTISEMENTContinue reading the main story42. Trump’s U.S.D.A. committed $124 Million to rebuild rural water infrastructure. 👀👀This is true, though in 2016 Mr. Trump pledged to spend more than $800 billion on infrastructure.43. Consumer confidence & small business confidence is at an all-time high.False. The all-time high for the Consumer Confidence Index is 144.7, which was reached in January and May of 2000, according to Lynn Franco, director of economic indicators and surveys at the Conference Board, which puts out the index.44. More than 7 million jobs created since the election.In January of 2020, there were about 152 million nonfarm jobs in the country — about seven million more than existed in January of 2017, according to the Bureau of Labor Statistics. But the number of jobs has been growing since 2010. In fact, the country gained more jobs — about eight million — between 2014 and 2017, the last years of the Obama administration. And since the pandemic began, between 10 million and 20 million jobs have been lost.45. More Americans are now employed than ever recorded before in our history.Given that there are more Americans alive now than ever in history, this would not be surprising. Regardless, it’s no longer true, because of the pandemic.46. More than 400,000 manufacturing jobs created since his election.It was true, but since the pandemic, the Trump administration has seen a net loss of about 200,000 manufacturing jobs, wiping out the past six years of growth, according to the Alliance for American Manufacturing. More than 900,000 manufacturing jobs were added between 2010 and 2016 during the Obama administration.47. Trump appointed 5 openly gay ambassadors. 👀👀True.48. Trump ordered Ric Grenell, his openly gay ambassador to Germany, to lead a global initiative to decriminalize homosexuality across the globe.Richard Grenell is leading an effort to decriminalize homosexuality around the globe. Mr. Grenell has said that Mr. Trump supports this effort, though its existence appeared to take Mr. Trump by surprise.ADVERTISEMENTContinue reading the main story49. Through Trump’s Anti-Trafficking Coordination Team (ACTeam) initiative, Federal law enforcement more than doubled convictions of human traffickers and increased the number of defendants charged by 75% in ACTeam districts.Convictions of human traffickers have not doubled. The number of convictions rose from 439 during Mr. Obama’s last year in office to 499 during Mr. Trump’s first year. In 2018, they rose again to 526 but then dropped back down again, to 475 in 2019.50. In 2018, the Department of Justice (DOJ) dismantled an organization that was the internet’s leading source of prostitution-related advertisements resulting in sex trafficking.True. But the sting against Backpage was years in the making. Authorities have had the website in their cross hairs since at least 2016.51. Trump’s OMB published new anti-trafficking guidance for government procurement officials to more effectively combat human trafficking.This is true. But the anti-trafficking community gives the Trump administration low marks because the administration’s harsh treatment of undocumented immigrants has caused victims of human trafficking to fear turning to authorities for help. The administration has made it harder for victims to obtain the special T visas they used to get when they turned to authorities for help and provided information about their abusers.52. Trump’s Immigration and Customs Enforcement’s Homeland Security Investigations arrested 1,588 criminals associated with Human Trafficking.See No. 51.53. Trump’s Department of Health and Human Services provided funding to support the National Human Trafficking Hotline to identify perpetrators and give victims the help they need.True. The hotline, which was founded in 2002, was also supported by the George W. Bush and Obama administrations.54. The hotline identified 16,862 potential human trafficking cases.See No. 51.55. Trump’s DOJ provided grants to organizations that support human trafficking victims — serving nearly 9,000 cases from July 1, 2017, to June 30, 2018.👀👀See No. 51.ADVERTISEMENTContinue reading the main story56. The Department of Homeland Security has hired more victim assistance specialists, helping victims get resources and support.See No. 51.57. President Trump has called on Congress to pass school choice legislation so that no child is trapped in a failing school because of his or her ZIP code. 👀👀Calling on Congress to do something is not really an accomplishment.58. The President signed funding legislation in September 2018 that increased funding for school choice by $42 million.Mr. Trump, who campaigned in 2016 on eliminating or drastically reducing the size of the Department of Education, tried to slash federal funding for public schools and dramatically increase funding for school choice and voucher programs. Congress overrode him. The $42 million is a small amount compared to the $400 million his administration initially proposed to expand charter schools and vouchers for private and religious schools.59. The tax cuts signed into law by President Trump promote school choice by allowing families to use 529 college savings plans for elementary and secondary education. 👀👀True. This is a tax break for those who send their children to private schools. Only a fraction of American families have these savings plans.60. Under his leadership, ISIS has lost most of its territory and been largely dismantled.American-led strikes against the Islamic State in Syria and Iraq began in 2014, predating the Trump administration. In 2018, Mr. Trump claimed in a tweet that ISIS had been defeated and ordered a withdrawal of U.S. troops within 30 days. He eventually gave military leaders more time after their objections. By 2019, the Islamic State had lost nearly all of its territory, but the group remains a threat.61. ISIS leader Abu Bakr al-Baghdadi was killed.Abu Bakr al-Baghdadi is said to have detonated a suicide vest during a 2019 raid by United States Special Operations forces.62. Signed the first Perkins C.T.E. reauthorization since 2006, authorizing more than $1 billion for states each year to fund vocational and career education programs.True.ADVERTISEMENTContinue reading the main story63. Executive order expanding apprenticeship opportunities for students and workers.True. Attempts to expand and modernize apprenticeships, a goal shared by Democrats, are widely seen as a bipartisan bright spot in the Trump administration.64. Trump issued an Executive Order prohibiting the U.S. government from discriminating against Christians or punishing expressions of faith.Mr. Trump signed an executive order that called for the vigorous enforcement of federal laws protecting religious freedom. Christians were not singled out.65. Signed an executive order that allows the government to withhold money from college campuses deemed to be anti-Semitic and who fail to combat anti-Semitism.True, though the American Civil Liberties Union expressed concern that the order could be used to punish constitutionally protected criticism of Israel or the Israeli government.66. President Trump ordered a halt to U.S. tax money going to international organizations that fund or perform abortions.True. Every Republican president has adopted a version of this policy since Ronald Reagan.67. Trump imposed sanctions on the socialists in Venezuela who have killed their citizens.True. The U.S. government has imposed sanctions on Venezuela for more than a decade. Additional sanctions imposed by the Trump administration have increased economic pressure on the government of Nicolás Maduro, who remains in power.68. Finalized new trade agreement with South Korea.Mr. Trump signed a revised version of the United States-Korea Free Trade Agreement, which had been in place since 2012. In 2017, Mr. Trump threatened to terminate the deal, which he said “should’ve never been made.” But the new version is considered similar to the old version, with a few tweaks.69. Made a deal with the European Union to increase U.S. energy exports to Europe. 👀👀True.ADVERTISEMENTContinue reading the main story70. Withdrew the U.S. from the job-killing TPP deal.Mr. Trump withdrew from the Trans-Pacific Partnership, a major change in U.S. trade policy. Experts disagree about the impact of the withdrawal on Americans jobs.71. Secured $250 billion in new trade and investment deals in China and $12 billion in Vietnam.This is true. China agreed to increase agricultural purchases by $12.5 billion in 2020 and $19.5 billion in 2021, compared with 2017 levels, but China is under no obligation beyond 2021.72. O.K.’d up to $12 billion in aid for farmers affected by unfair trade retaliation. 👀👀The Trump administration announced a total of $28 billion in aid for farmers in 2018 and 2019, and another $23.5 billion through the coronavirus stimulus package passed in March.73. Has had over a dozen U.S. hostages freed, including those Obama could not get freed.This is true. Mr. Obama amended a longstanding U.S. policy not to negotiate with hostage-takers, making it more flexible. Mr. Trump continued to push the envelope on what could be done to release hostages, earning praise from those who view his efforts as a major foreign policy success and criticism from others who accuse Mr. Trump of authorizing the payment of de facto ransoms, incentivizing terrorists to take more American hostages.74. Trump signed the Music Modernization Act, the biggest change to copyright law in decades.True.75. Trump secured Billions that will fund the building of a wall at our southern border.Mr. Trump promised in 2016 that Mexico would pay for the wall. What happened?76. The Trump Administration is promoting second-chance hiring to give former inmates the opportunity to live crime-free lives and find meaningful employment.See No. 77.ADVERTISEMENTContinue reading the main story77. Trump’s DOJ and the Board Of Prisons launched a new “Ready to Work Initiative” to help connect employers directly with former prisoners. 👀👀This is true, though it is unclear how many people have been able to participate in it.78. President Trump’s historic tax cut legislation included new Opportunity Zone Incentives to promote investment in low-income communities across the country.True. Experts disagree about whether these zones will benefit low-income communities, or just wealthy developers.79. 8,764 communities across the country have been designated as Opportunity Zones.True. See No. 78.80. Opportunity Zones are expected to spur $100 billion in long-term private capital investment in economically distressed communities across the country.See No. 78.81. Trump directed the Education Secretary to end Common Core. 👀👀👀👀👀👀👀👀👀Mr. Trump promised in 2016 to end Common Core, but according to PolitiFact, 37 states still use some version of it.82. Trump signed the 9/11 Victims Compensation Fund into law.True. Members of both political parties in Congress deserve much of the credit.83. Trump signed measure funding prevention programs for Veteran suicide. 👀👀True. And congressional supporters of these programs say the White House has been supportive.ADVERTISEMENTContinue reading the main story84. Companies have brought back over a TRILLION dollars from overseas because of the TCJA bill that Trump signed.True. TCJA refers to the president’s 2017 overhaul of federal tax law.85. Manufacturing jobs are growing at the fastest rate in more than 30 years.According to the Alliance for American Manufacturing, the rate of growth of manufacturing jobs in 2018 was impressive, but similar rates were achieved in 1994, 1997, 2011 and 2014.86. Stock Market has reached record highs.The highest closing record of the Dow Jones industrial average, the index of 30 top U.S. companies, was reached in February, after investors appeared to be encouraged that the trade wars initiated by Mr. Trump were being resolved. Recent interest-rate cuts in 2019 also contributed. This March, the Dow fell a record 2,013.76 points to 23,851.02, after it became clear that the U.S. economy would lock down because of the pandemic. That drop was followed by two more record-setting point drops.87. Median household income has hit the highest level ever recorded.This is true.88. African-American unemployment is at an all-time low.See No. 40.89. Hispanic-American unemployment is at an all-time low.See No. 40.90. Asian-American unemployment is at an all-time low.This was true before the coronavirus struck.ADVERTISEMENTContinue reading the main story91. Women’s unemployment rate is at a 65-year low.This was true before the coronavirus struck.92. Youth unemployment is at a 50-year low.This appears to have been true, before the coronavirus struck. But the labor force participation rate for young Americans is not as high as it was in 1989.93. We have the lowest unemployment rate ever recorded.This is false. Unemployment rates were lower in the 1950s, according to the Bureau of Labor Statistics.94. The Pledge to America’s Workers has resulted in employers committing to train more than 4 million Americans.In 2018, President Trump launched the Pledge to America’s Workers, aimed at boosting the private sector’s role in training American workers. Companies signed on, to much fanfare. But there is evidence that resources for training are actually going down.95. 95 percent of U.S. manufacturers are optimistic about the future — the highest ever.This was true in 2018, but since the pandemic that number has dropped to 34 percent.96. As a result of the Republican tax bill, small businesses will have the lowest top marginal tax rate in more than 80 years. 👀👀Not really. According to the Tax Foundation, the lowest top marginal rate in the past 80 years was 28 percent in the 1980s, although a “claw back” provision in the 1980s increased the top marginal rate to 33 percent for taxpayers with incomes over certain thresholds. Under current law, the top marginal rate is 37 percent, but pass-through businesses can receive additional tax breaks to lower their top marginal rate to 29.6 percent.97. Record number of regulations eliminated that hurt small businesses.This appears to be true. Mr. Trump has made reducing regulations a signature part of his legacy. He signed an executive order directing all agencies to repeal at least two existing regulations for each new regulation issued in the 2017 fiscal year and thereafter. A list of regulations that have been removed is being compiled by the Brookings Deregulation Tracker.ADVERTISEMENTContinue reading the main story98. Signed welfare reform requiring able-bodied adults who don’t have children to work or look for work if they’re on welfare. 🙌🙌The Trump administration released guidance in January 2018 that lets states take away Medicaid coverage from people who aren’t working or engaged in work-related activities. Tens of thousands of people have been affected. For instance, in Arkansas over 18,000 Medicaid beneficiaries lost coverage in 2018, according to the Center on Budget and Policy Priorities.99. Under Trump, the FDA approved more affordable generic drugs than ever before in history.True. Scott Gottlieb, the former commissioner of the Food and Drug Administration, was praised for his efforts to streamline the process of drug approval before he left the administration.100. Reformed Medicare program to stop hospitals from overcharging low-income seniors on their drugs — saving seniors 100’s of millions of $$$ this year alone. 👀👀It’s true that the Trump administration changed the rules for how Medicare pays for prescription drugs through the 340B program, lowering the rate that hospitals are reimbursed for drugs, which in some cases lowers co-payments for seniors, according to the Kaiser Family Foundation. It is not clear how much seniors have saved through this change.101. Signed Right-To-Try legislation allowing terminally ill patients to try an experimental treatment that wasn’t allowed before.True. Some argue that a similar program that existed previously under the Food and Drug Administration was less risky.102. Secured $6 billion in new funding to fight the opioid epidemic. ❤️❤️According to the U.S. Department of Health and Human Services, $9 billion in new grant funding was awarded to states and local communities to help increase access to treatment and prevention services during the first three years of the Trump administration.103. Signed VA Choice Act and VA Accountability Act, expanded V.A. telehealth services, walk-in-clinics, and same-day urgent primary and mental health care. 👀👀Mr. Trump has signed a number of bipartisan bills that call for improvements to medical care for veterans, including more access to walk-in clinics.104. U.S. oil production recently reached an all-time high so we are less dependent on oil from the Middle East.True. (Duplicate of No. 7.)ADVERTISEMENTContinue reading the main story105. The U.S. is a net natural gas exporter for the first time since 1957.True. According to the U.S. Energy Information Administration, the United States began ramping up its exports of liquefied natural gas in 2016, and became a net exporter of natural gas during the Trump administration.106. NATO allies increased their defense spending because of his pressure campaign.True. Although NATO countries were already modestly increasing their military spending before Mr. Trump took office, there is evidence that his public complaints led to a deal that allowed the United States to decrease its own spending, while some other countries increased their share each year that he has been in office.107. Withdrew the United States from the job-killing Paris Climate Accord in 2017 and that same year the U.S. still led the world by having the largest reduction in carbon emissions. 👀👀It is true that Mr. Trump announced that the United States would withdraw from the Paris Climate Accord. Experts disagree on whether the accord would have created American jobs or destroyed them.108. Has his circuit court judge nominees being confirmed faster than any other new administration.It is not clear how to measure this across every U.S. administration, but it is an ironic thing to highlight, given that Republicans systematically blocked Mr. Obama’s judicial nominees.109. Had his Supreme Court Justice’s Neil Gorsuch and Brett Kavanaugh confirmed.True.110. Moved U.S. Embassy in Israel to Jerusalem. 👀👀True.111. Agreed to a new trade deal with Mexico & Canada that will increase jobs here and $$$ coming in.The Trump administration updated the North American Free Trade Agreement, fulfilling a campaign promise.ADVERTISEMENTContinue reading the main story112. Reached a breakthrough agreement with the E.U. to increase U.S. exports.True. The agreement aims to resolve a longstanding dispute about a European Union ban on hormone-fed U.S. beef. But tensions over Mr. Trump’s 25 percent tariffs on some European goods remain.113. Imposed tariffs on China in response to China’s forced technology transfer, intellectual property theft, and their chronically abusive trade practices, has agreed to a Part One trade deal with China.True, though China has reportedly pulled back from its commitments in that deal amid the pandemic.114. Signed legislation to improve the National Suicide Hotline. 👀👀See No. 83.115. Signed the most comprehensive childhood cancer legislation ever into law, which will advance childhood cancer research and improve treatments.The Childhood Cancer Survivorship, Treatment, Access and Research Act has been called the most comprehensive childhood cancer bill taken up by Congress. It was championed by a bipartisan group of lawmakers and passed unanimously in 2018.116. The Tax Cuts and Jobs Act signed into law by Trump doubled the maximum amount of the child tax credit available to parents and lifted the income limits so more people could claim it.True. According to the Tax Foundation, the Tax Cut and Jobs Act doubled the maximum child tax credit from $1,000 to $2,000, while the phaseout threshold was increased from $75,000 to $200,000 for single filers and $110,000 to $400,000 for married couples filing jointly.117. It also created a new tax credit for other dependents.True. There is now a nonrefundable $500 credit for certain dependents who do not meet the child tax credit eligibility guidelines.118. In 2018, President Trump signed into law a $2.4 billion funding increase for the Child Care and Development Fund, providing a total of $8.1 billion to states to fund child care for low-income families.It is true that Mr. Trump signed this bill. Congress should also get the credit for passing it.ADVERTISEMENTContinue reading the main story119. The Child and Dependent Care Tax Credit (CDCTC) signed into law by Trump provides a tax credit equal to 20-35% of child care expenses, $3,000 per child & $6,000 per family + Flexible Spending Accounts (F.S.A.s) allow you to set aside up to $5,000 in pre-tax $ to use for child care.According to the Tax Foundation, this is an accurate description of the Child and Dependent Care Tax Credit, but it’s important to note that the Tax Cuts and Jobs Act did not directly change the rules for the credit. Those rules existed before the Trump administration. So did the $5,000 dependent care Flexible Spending Accounts.120. In 2019 President Donald Trump signed the Autism Collaboration, Accountability, Research, Education and Support Act (CARES) into law, which allocates $1.8 billion in funding over the next five years to help people with autism spectrum disorder and to help their families. 👀👀It is true that Mr. Trump signed this bill into law. Congress deserves the credit for passing this legislation, which received such broad support that 173 House members and 41 senators were co-sponsors.121. In 2019 President Trump signed into law two funding packages providing nearly $19 million in new funding for Lupus specific research and education programs, as well an additional $41.7 billion in funding for the National Institutes of Health (NIH), the most Lupus funding EVER.True. The measure was championed by the bipartisan Congressional Lupus Caucus.122. Another upcoming accomplishment to add: In the next week or two Trump will be signing the first major anti-robocall law in decades called the TRACED Act (Telephone Robocall Abuse Criminal Enforcement and Deterrence.) Once it’s the law, the TRACED Act will extend the period of time the FCC has to catch & punish those who intentionally break telemarketing restrictions. The bill also requires voice service providers to develop a framework to verify calls are legitimate before they reach your phone.True. Congress gets credit for passing this law with bipartisan support. Even under the TRACED Act, the power of the F.C.C. to punish robocallers is limited.