Fox & Friends Explains “Doughnut Hole” By Creating Fictional Patient Who Doesn't Reach It

Senate Democrats Cited “Doughnut Hole” Fix in Warning Boehner They Would “Block” Health Care Repeal. On January 3, Senate Democratic leadership reportedly sent incoming House Speaker John Boehner (R-OH) a letter which warned: “If House Republicans move forward with a repeal of the health care law that threatens consumer benefits like the 'doughnut hole' fix, we will block it in the Senate. ...This proposal deserves a chance to work. It is too important to be treated as collateral damage in a partisan mission to repeal health care.” [Politico, 1/3/11]

Fox & Friends Invents “Charley Smith,” A Fictional Patient With Low Drug Costs, To Explain The Coverage Gap. Reporting on the Democrats' letter, Fox & Friends co-host Steve Doocy purported to explain the gap between normal Medicare Part D coverage and catastrophic coverage by inventing a fictional patient named “Charley Smith.” In Doocy's fictional scenario, Charley Smith's drug costs were below the level where he would enter the coverage gap, leading Doocy to conclude, “Since Charley did not reach the $2,840 initial coverage limit, he will not enter the doughnut hole.” The only explanation offered for a patient who might enter the coverage gap came from Doocy's co-host Brian Kilmeade, who said:

KILMEADE: And then when you hit the coverage limit, you got to pay everything. And then when you get to that 2,840 coverage limit, then you're writing the check, and then all of a sudden, the answers will come in, you'll get insurance. [Fox News' Fox & Friends, 1/4/11]

Later in the show, Doocy accurately outlined the various coverage levels, but did not explain how the health care reform legislation addressed the doughnut hole.

In Reality, Millions Of Seniors Are Affected By The Doughnut Hole

The Part D Coverage Gap Leaves Seniors Paying Full Price For Prescription Drugs Until “Catastrophic Coverage” Kicks In. Medicare Part D offers coverage for beneficiaries' prescription costs. The way the plan is structured, a patient is responsible for a co-payment and deductible, and the plan shares prescription drug costs until the total cost of all prescription drugs in a year reaches $2,830. At that point, beneficiaries are responsible for paying 100 percent of their prescription drug costs until the total cost reaches $6,440. After that, 95 percent of the costs are covered by “catastrophic coverage.” The gap between the normal coverage and catastrophic coverage, during which seniors are responsible for all drug costs, is known as the Part D coverage gap, or “doughnut hole.” [Department of Health and Human Services, accessed 1/4/11; Kaiser Family Foundation, “The Medicare Prescription Drug Benefit,” accessed 1/4/11]

Kaiser Family Foundation: 3.4 Million Seniors Reached Coverage Gap In 2007. According to the Kaiser Family Foundation's Medicare Chartbook, 26 percent of Medicare Part D enrollees who “filled one or more prescriptions but did not receive low-income subsidies in 2007” reached the coverage gap. According to KFF's estimate, this accounted for 3.4 million seniors in 2007, or 14 percent of all Part D enrollees. From the Kaiser Family Foundation:

[Kaiser Family Foundation's Medicare Chartbook, Fourth Edition, 2010, accessed 1/4/11]

Ingraham Falsely Suggests Health Care Bill Does Not Address Coverage Gap

Ingraham Challenges Sen. Schumer To “Point The Page Number And Paragraph ... Where The Doughnut Hole Is Fixed.” Later on Fox & Friends, co-host Gretchen Carlson claimed that “nobody knows what the heck [the doughnut hole] is.” Guest Laura Ingraham responded: “You then have to ask Senator Schumer: Point to -- point the page number and paragraph, subparagraph number, where the doughnut hole is fixed. I mean, these guys don't even know what's in this legislation, all right?” [Fox & Friends, 1/4/11]

Coverage Gap Is Addressed in Section 3301 Of The Bill

Section 3301 Outlines The “Medicare Coverage Gap Discount Program,” Which Provides Discounts To Beneficiaries In Coverage Gap. The doughnut hole is addressed by the “Medicare Coverage Gap Discount Program,” which can be found on page 343, Subtitle D, Section 3301 of the Patient Protection and Affordable Care Act of 2010, as passed by the House and Senate. As the Los Angeles Times reported, beginning in 2010, “any Medicare beneficiary who crosses into the doughnut hole will receive a $250 check to help pay for the drugs. Then, starting in January [2011], patients in the coverage gap will get a 50% discount on brand-name drugs.” [Government Printing Office, accessed 1/4/11; Los Angeles Times, 3/26/10]