A week ago, Trump took to his Truth Social safe space to make a specious claim about a problem vexing millions of diabetic Americans on Medicare, the out-of-pocket/copay cost of insulin, one of the more contentious political issues of the day, especially since Medicare beneficiaries comprise a population with higher prevalence of diabetes (33%, 22 million) than the general population (11%, 37 million). More than three million people with Medicare coverage use insulin.
So, let us ask of the man who spent much of his administration trying to repeal the Affordable Health Care Act, “What would a serious and informed policy disagreement about Medicare and insulin coverage be without Donald Trump?” Asked and answered last Saturday:
“Low INSULIN PRICING was gotten for millions of Americans by me, and the Trump Administration, not by Crooked Joe Biden. He had NOTHING to do with it. It was all done long before he so sadly entered office. All he does is try to take credit for things done by others, in this case, ME!” Truth Social, June 8, 2024
This is firstly, stupid, and secondly, nonresponsive, simultaneously both false and true, a hallmark of Trump & Company. It’s a technique that confuses those who do not follow the ins-and-outs of government policy, and many who do follow it. Trump’s Truth Social post conflates outright lying with some actual facts that, on analysis, are, indeed, truthful, but that don’t advance Trump’s argument. Given that, his argument is iconically specious, i.e., apparently good or right though lacking real merit; superficially pleasing or plausible. So, let’s dig in and deconstruct.
Trump Administration’s Half-Baked Accomplishment
“I don’t use insulin, Should I be? Huh? I never thought about it.
But I know a lot of people are very badly affected, right? Unbelievable.”
Donald Trump, a nondiabetic, displaying
his advanced knowledge of the subject
USA Today, May 26, 2020
The above crackpot quote was served up by then President Trump at a May 26, 2020 formal White House Rose Garden speech about, among other things, an executive action reducing the copay cost of insulin to $35 for Medicare recipients. Here’s the summary excerpt from the White House (ironically named) Fact Sheet released during that Rose Garden speech:
LOWERING COST OF INSULIN FOR SENIORS: President Donald J. Trump and his Administration are lowering out-of-pocket insulin costs for Medicare’s seniors.
“Under President Trump’s leadership, the Centers for Medicare & Medicaid Services is announcing that many Medicare Part D plans and Medicare Advantage plans have applied to offer lower out-of-pocket insulin costs to seniors for the 2021 plan year.
Across the Nation, participating enhanced Part D plans will provide many seniors with Medicare access to a broad set of insulins at a maximum $35 copay for a month’s supply of each type of insulin.
And,
Lowering out-of-pocket insulin costs will provide the many Medicare beneficiaries who rely on one or more common forms of insulin with plan options that will deliver critical relief.
And,
No effort will be spared to give America’s seniors the care and support and devotion and love they have earned and that they deserve. President Donald J. Trump, March 26, 2020
In fact, rather than sparing no efforts, Trump administration’s policy spared many efforts. Unrevealed was that the cost cap would apply to only a small subset of 3.5 million insulin-dependent Medicare beneficiaries, and they were still stuck with a yearly deductible. That’s a big “unreveal” that affected many. Nonetheless, the Fact Sheet excerpt reads as if all insulin-dependent Medicare beneficiaries would receive the new copay cost cap. So, factually, Trump’s policy did lower insulin costs, but despite being presented as a cure-all for Medicare patients, it was misleadingly presented, ergo, factual but largely false since so many on Medicare were left out.
For Trump, even this half-baked policy was something he didn’t want to establish, nor did the pharmaceutical CEOs, or insulin suppliers who colluded with him design it as anything more than a sop to the Medicare voting bloc. Trump had been suffering some blowback on the issue and needed something that he knew he could sell as a major accomplishment to his diabetic MAGA Medicare recipients (many of whom were excluded from the insulin cap). Nonetheless, at a 2020 presidential debate Trump boasted that lowered insulin prices that vials were “so cheap, it’s like water”, despite insulin prices remaining fixed at about $300 per vial. And that wasn’t misleading, that was 100% false.
The Biden Administration’s Meaningful Accomplishment
Jump forward from the Trump administration’s weak insulin copay cost policy to today. President Biden achieved much when he signed the August 2022 Inflation Reduction Act. Among those achievements was a new insulin copay cap program (effective date January 1, 2023 for Medicare Part D, and July 1, 2023 for Medicare Part B). Also, as of January 1, 2024, eligibility for the Part D Low Income Subsidy (LIS) expanded from 135 percent of the Federal Poverty Level (FPL) to 150 percent of FPL, which allows these enrollees to further reduce their out-of-pocket costs for insulin. Also, under the Inflation Reduction Act, beginning in plan year 2023 (Jan-Dec), Medicare Part D enrollees no longer may have a deductible for insulin and must have a maximum $35 monthly co-payment. These are broad and meaningful benefits, rather than – as Trump’s 2020 executive action was – a simply cynical political expedient to attempt to silence critics by, basically, confusing them. (Note, however, as always, Senate Republicans tried to block the $35 cap on price of insulin from the Inflation Reduction Act.)
As the copay cap program became effective in January 2023, an October HHS report, Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics, disclosed:
KEY POINTS
• The Inflation Reduction Act (IRA) caps insulin out-of-pocket spending at $35 per month’s supply of each insulin product covered under a Medicare Part D plan, with similar limits for out-of-pocket costs for insulin supplied under Part B, and reduces out-of-pocket drug spending in Medicare in other ways.
. . . [Omitted — States that the study used data below based upon analysis of 2019 data]
• Nationally, [during 2019, Trump administration] the average out-of-pocket cost was $58 per insulin fill, typically for a 30-day supply. The average cost per fill among people who were uninsured for the entire year was $123, more than double the national average. Patients with private insurance or Medicare paid about $63 per fill on average.
• [During 2019] About 37 percent of insulin fills for Medicare enrollees (Part B and Part D) required cost-sharing exceeding $35 per fill, including 24 percent that exceeded $70 per fill. About 36 percent of insulin fills for people without insurance and 35 percent for people with private insurance had cost sharing above $35 per fill. These estimates are only for enrollees who filled an insulin prescription and do not include potential costs for patients who did not fill their insulin due to cost or other reasons.
• We estimate that 1.5 million Medicare beneficiaries would have benefited from the new [Inflation Reduction Act] insulin cost-sharing limits if they had been in effect [during] 2020, [rather than Trump’s policy] with savings to those beneficiaries of about $734 million in Part D and $27 million in Part B – or approximately $500 in average annual savings per person among those benefiting from the provision. [Emphasis added]
The Trump plan lacked coverage for millions of Medicare insulin users. The Inflation Reduction Act remedied that.
Jump Forward to . . . Last Saturday & Donald Trump
Yes, this again:
“Low INSULIN PRICING was gotten for millions of Americans by me, and the Trump Administration, not by Crooked Joe Biden. He had NOTHING to do with it. It was all done long before he so sadly entered office. All he does is try to take credit for things done by others, in this case, ME!” Truth Social post, June 8, 2024
Why now, why this spirited defense? The closeness of the 2024 election, in time and in winning margin, sespite Trump’s overwhelming confidence, he may have been alerted to the fact that today’s seniors, particularly baby boomers over 64, are not majority GOP voters seniors as we’ve assumed. And Trump relies on them, and trusts them to support him, and boomers now represent 60+% of the senior vote. More conservative or radical voters have died since the 2016 and 2020 elections at a greater number than baby boomers have joined the senior voting bloc. An April 26 NYT article succinctly summed it up:
“Mr. Biden’s strength among seniors might be surprising, but the likeliest explanation is deceptively simple: At every stage earlier in their lives, many of today’s seniors voted Democratic. They just got older.”
As a 74 year-old baby boomer I unanimously agree. (I’m also a diabetic who once used insulin and now use Ozempic exclusively: O! O! O! Ozempic!) Given the millions of Medicare insulin-dependent patients, insulin costs – Trump may have learned is a salient issue in the presidential race and as the chart below suggests, the blue seniors still retain their leftie reputation:
And since the 2012 election, much has changed. Baby boomers could decide the 2024 election, although Gen Z voters appear to be trending more conservative/MAGA, older voters vote in greater percentage terms than younger ones. Therefore, if not Trump himself, then it’s likely someone in the Trump campaign alerted him that the Medicare voting bloc was at risk, not only on general issues, but on pocketbook issues like the Medicare insulin cap. It’s unlikely, however, that many approved of his outlandish June 8th tweet and the blowback that established how cynical and untrue it was. We baby boomers aren’t babies anymore and we are still predominantly hippies . . .
