U.S. Health and Human Services Secretary Sylvia Mathews Burwell has prepared this Cabinet Exit Memo, describing some of the accomplishments of the Obama Administration over the past 8 years, and outlining the key issues facing the Department of Health and Human Services in the incoming Trump Administration.

Among the highlights of the accomplishments:

  • 20 million more Americans have health insurance coverage because of the Affordable Care Act’s expansion of Medicaid, creation of health insurance marketplaces, and other protections and expansions of coverage
  • no insurer can impose annual or lifetime dollar limits on coverage, all plans are required to place dollar limits on out-of-pocket costs, and women can’t be charged more than men just because of their gender
  • more than 138 million Americans can get immunizations, cancer screenings, and other recommended preventive services without a copayment
  • the ACA closed the Part D “donut hole,” helping more than 11 million people with Medicare save over $23.5 billion on prescription drugs, an average of $2,217 per beneficiary
  • between 2010 and 2015, hospitals prevented an estimated 565,000 patient readmissions through changes that improve the quality of care and avoid unnecessary costs; hospital-acquired conditions such as ulcers, infections, and other avoidable traumas decreased, with an estimated 125,000 lives saved and nearly $28 billion in cost savings
  • explicit goals were established to move Medicare to pay for value, not volume: by the end of 2016, 30 percent of Medicare payments would be based on alternative payment models, increasing to 50 percent by the end of 2018; the 30 percent goal was achieved ahead of schedule
  • the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 mobilized a national effort to digitize medical information; the adoption of electronic health records has tripled since then
  • successfully fought health threats posed by H1N1, the Ebola virus, and the Zika virus
  • based on the enactment in 2009 of the bipartisan Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (FDA) extended its regulatory authority to all tobacco products, including e-cigarettes, cigars, and hookah tobacco, restricting their sale to minors, and helps the FDA prevent misleading claims by tobacco product manufacturers
  • continues combatting the opioid crisis with an evidence-based three-part strategy, focused on improving prescriber practices, expanding access to medication-assisted treatment to help people fight addiction, and expanding the use of naloxone to save people from an overdose
  • the ACA made mental health and substance use disorder services an essential health benefit that plans in the individual and small group markets must cover, assisting more than 170 million Americans with improved insurance coverage for mental health and substance use disorder care
  • increased funding for the Indian Health Service by 43 percent through Fiscal Year 2016 and established the Secretary’s Tribal Advisory Committee (STAC), the first-ever such advisory body at the Cabinet level; the ACA included a permanent reauthorization of the Indian Health Care Improvement Act
  • under the ACA, individuals can no longer be denied health care or health coverage based on their sex; individuals must be treated consistent with their gender identity; and explicit categorical exclusions in coverage for all health care services related to gender transition are considered discriminatory
  • expanded the number of children attending Head Start for a full school day and year, ultimately ensuring that nearly all eligible children have access to such programs by 2021.

Among the key issues for the new Administration:

  • continue progress under the ACA to expand access and improve coverage quality; repealing sections of the ACA without any comparable replacement legislation would result in nearly 30 million Americans losing their health insurance coverage
  • the 19 states that have not yet expanded Medicaid have the opportunity to provide coverage to 4 million of their residents, while strengthening their economies and their health care systems
  • additional payment incentives to drive the delivery of value-based health care throughout the entire health care system, improve the interoperability of data, and integrate care
  • establish a Public Health Emergency Fund so that the federal government can rapidly respond to urgent health threats; having such a reserve of resources would save lives, save money, and protect America’s health security
  • tobacco use continues to be the leading cause of preventable disease and death in the United States; protecting America’s youth from the harmful effects of tobacco products, such as e-cigarettes and flavored cigars, should continue to be a top priority for the federal government
  • empower families with information about the foods and beverages they consume.
  • continue to expand access to high quality early childhood education from birth through age four.

Secretary Burwell concludes with her personal testimony:

“A little more than four decades ago, a young girl took a seat in a classroom in a small town in West Virginia for a new program called Head Start. In that room, she would make lifelong friends and spark a love of learning that she would carry with her into a career of public service, and eventually the chance to serve as Secretary of the Department of Health and Human Services. My path to serve this Department and the American people was made possible by generations before me—generations of men and women who knew that the role of public service is to lift up families and empower communities….Our Department shines the brightest when we connect those Americans with the realities of the challenges and opportunities ahead. We fulfill our mission every time we help the American people have real conversations about the real choices they face. Whenever we put the American people at the center of their decisions and empower them, our nation grows stronger. That has been our goal at the Department of Health and Human Services throughout President Obama’s Administration, and I hope it continues to be the legacy of this Department well into the future. It has been a privilege to serve with this team.”

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