“We’ve Closed the Doughnut Hole” (And Other ObamaCare Lies)

by Chris Angelini

Recently, on FOX News Sunday with Chris Wallace, regular panelist Juan Williams was extolling the benefits of ObamaCare that Americans are discovering:   “Although last year’s health care conversation revolved around death panels, socialism and how ObamaCare is going to end the world … now as we’ve closed the doughnut hole, said your kids can stay on your insurance until they’re 26, and guaranteed [that] insurance companies can’t eliminate people with pre-existing conditions, the American people are coming to say this is a good idea and the Republicans have nothing.”  Unfortunately, all three of these triumphant claims are flawed.

1) Pre-existing-condition coverage is old news

From the very start of President Obama’s perpetual ObamaCare promotion tour, Republicans were hoodwinked into perpetuating the notion that ObamaCare mandates a new benefit:  pre-existing-condition coverage.  On numerous occasions, asleep-at-the-wheel Republicans have regurgitated the Democrats’ talking point that extending coverage to those with pre-existing conditions is one of the few good parts of the bill.  But the facts and the congressional record show that this claim is specious.

It was President Clinton who signed into law the Health Insurance Portability and Accountability Act of 1996, which forbids health insurance companies from denying coverage to people with pre-existing conditions.  Despite its 2,400 pages and 425,000 words, the ObamaCare act offers no substantive changes to existing law and simply preserves the status quo.

2) Coverage to age 26:  Delaying adulthood

ObamaCare uses the full force and weight of our government to encourage young adults who have been fed, clothed and educated for 20 years by their parents to remain dependent on those parents and renounce responsibility for another six years — well past college. While not compulsory, ObamaCare pressures parents to remain liable for their adult children’s health care costs.  The government thereby insinuates itself into the relationship between parents and children.

To many, the coverage age extension will come as an unwelcome obligation, because it is standard practice for companies to enroll newly hired employees into their group health care plans.  Allowing adult children to remain on their parents’ health insurance for years after graduation will decrease the total number of participants in corporate group plans.  This membership decrease will inevitably lead to higher costs and fewer benefits for remaining plan participants.  Guilt-ridden parents on fixed incomes will be forced to pay the premiums of their irresponsible adult children who fail to contribute.

3) The doughnut hole is NOT closed

The most misleading ObamaCare claim is that it eliminates the infamous Medicare prescription “doughnut hole.”  Everyone following the ObamaCare debate has heard the president and his minions shamelessly extol this “fix” as the single greatest gift to seniors since the inception of Medicare.  Unfortunately the facts paint an entirely different picture.

The doughnut hole refers to the gap where Medicare does not reimburse the cost of a member’s prescription drugs.  It begins at the point when the total amount paid for drugs by the insurance carrier, combined with the co-payments of the Medicare Part-D participant, reaches $2,840 dollars in a calendar year.  While in the doughnut hole, the participant is responsible for 100 percent of all drug costs.  The doughnut hole ends once the participant has spent $4,550 out-of-pocket.

The closing of the doughnut hole was deliberately scheduled to take effect immediately in January 2011 in the hope that it would increase support for ObamaCare among seniors.  Yet, as my personal experience shows, Medicare providers are clueless about this new benefit, which is hardly as good as it’s cracked up to be.

Early this year, I was called by a pharmacy and told that my uncle, whose insurance matters I handle, had fallen into the Medicare doughnut hole.  The pharmacist explained that instead of my uncle’s normal co-payment, the price for one of his prescriptions would now be $1,095 per month.  I immediately called my uncle’s insurance company, AARP Medicare Complete/SecuredHorizons, Oxford Health Plans.  An hour or so into the phone call — after speaking to a representative, getting transferred to a supervisor, being disconnected, calling back, and finally transferred again — a manager told me that the $1,095 price actually represented a $300 dollar savings due to ObamaCare.  It was clear that no one had the vaguest idea of what the fix fixed.  The hole appeared to still be wide open.

A week later, I called again.  As before, the customer service representative and supervisor were oblivious to the doughnut-hole fix.  This time, though, I was transferred to a Medicare-Part D prescription drug specialist/manager, who explained the bewildering new guidelines to me.

Here’s the skinny:  The last drug my uncle purchased in January 2011 put him $795 dollars over the $2,840 coverage limit, and into the doughnut hole.  According to the prescription manager, my uncle had to pay the full price for the drug, minus 50 percent of the total money spent in the doughnut hole.  In other words, because of ObamaCare, instead of spending $1,095 that month for one drug, my uncle had to spend  $1,095 – ($795 x 50%), or $697.50 for it.  This is an improvement to, but NOT the elimination of, the doughnut hole.  Close but no cigar.

This so-called fix is complex, unwieldy and torturous.  Pharmacies are not privy to the total amount individual Medicare patients have spent and patients are not furnished with the amounts expended by their insurance carrier until at least a month after each transaction.  Furthermore, many of the elderly who fall into the doughnut hole are in poor health and don’t have someone like me, willing to spend hours on the phone with their Medicare providers.  In most cases, seniors will have to pay the full price and then be obligated to go through the hassles of getting their insurance carriers to reimburse them — which few have the time or energy to do.

Juan Williams needs to do his homework on ObamaCare.  His claims, the same as those parroted by the Democrats, are wrong-headed (coverage to 26), exaggerated (doughnut hole closed) or false (pre-existing-condition coverage).  It is nauseating to hear the Democrats’ talking points endlessly spewed, especially when they’re spewed by a FOX News pundit with a lucrative new contract.

Chris Angelini is a Constitutional Conservative dedicated to self reliance and individual liberty.

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7 years ago

I lost my adap this year due to a increase in my social security of less than $50.00, and adap new guide lines.
So now next year in March 14th I will have no medical insurance for meds (part D) already this year paying
the copays with out and 2nd insurance is way out of my budget. I am so lucky to have insurance, but my budget
doesn’t allow for big increases, and giant ones means no meds at all. Each month 14 different meds, cost per
month $1,650.00. Adap paid 100% of $1,200.00 and the balance was copays, which I paid.
I for years have written, e-mailed, phoned drug companies for help during donut holes periods.
The only help I get is from my doctor and his drug reps. Their is a company that sells off price drugs for cheaper
I need my doctor to write a perscripition, it doesn’t make him happy not knowing where these meds are
coming from, better then nothing, But next year I will not have adap and their money to get me thru the
donut hole. So this is why I would like to see the hole filled up, if you have any suggestions to get over
the gap let me know.(I cannot change my social security)

8 years ago

“This is an improvement to, but NOT the elimination of, the doughnut hole.”

This is NOT an improvement! It’s your uncle sucking at the trough of public welfare. Accept personal responsibility as your savior. Ron Paul 2012!

8 years ago
Reply to  Pete

Pete, every single aspect of Obamacare is a disgrace. It has Absolutely Nothing to do with Healthcare. It has nothing to do with fixing or reform American’s heath care It is 100% about Control – Govt seizing control of the citizenry.
Also, I originally wrote this for a conservative publication almost a year ago; for AMAC it was toned down. Nothing is good about Obamacare, or the criminal “Punish the Tax Payer” Big Govt healthcare system we have now.

8 years ago
Reply to  Chris

According to newshealth, aptmoxirapely 6 million Americans each year flock abroad for affordable medical and or dentistry. Most of the Americans taking this risk are either uninsured or underinsured. Way too many are being butchered by unqualified doctors in 3rd world countries. Please click on my u-tube name and watch my brief powerful true story medical tourism Nightmare in San Jose Costa Rica . I have no political reasons for this video but, I do? hope it will save millions of people !

8 years ago

so you’re basing your rant on what a TV panelist said. I look at it as any help is better than none. So why don’t you just tell them you don’t want obamacare and pay the full $1095 ?

The doughnut hole is a tremendous problem. I am a transplant recipient, when I get my first 3 month supply of prescriptions not only am I already in the ‘hole’ but I am better than 50% into the the $4600 out of pocket, my next prescriptions get me to the catastrophic level. Problem is I’m no longer working where am I supposed to get $4600? do I just stop and die?

8 years ago
Reply to  Lew

Lew, I AGREE, every problem in our current Healthcare system was caused by Government meddling or at the least, abetted by Big Government’s “subdue the free market” Statist policies. God bless you and live long


jack Arnet
9 years ago


8 years ago
Reply to  jack Arnet

You’re an idiot

Susan R
9 years ago

Something that does need to be fixed is the two year wait to get on medicare when someone goes on disability. This puts a very vunerable group of people in the position of not having medical insurance, who greatly need it.

Charles Colburn
9 years ago

All this law is about the Fed. Gov.taking more fredoms awayfrom the people.The Deomocrats think the general public is stupid. This is partly true because of our faild education system, which teaches dumbing down to all students..And the government should make most decisions for everyone that is not in the government.

8 years ago

From a teacher…you’re an idiot

7 years ago
Reply to  John

Hey smart Democrat teacher, with so many facts now in public view, who’s the idiot? I can only imagine how many kids you must of screwed up, teaching them your leftist utopian delusions. Shame on you.

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