In 2014, national spending on health care products and services totaled $3.1 trillion, or $9,695 per person, and accounted for 17.4 percent of our gross domestic product (GDP). Medicaid enrollment grew by 12.9 percent in 2014, while spending on the program grew by 12 percent (federal and state spending grew 17.7 percent and 3.4 percent, respectively) totaling $503.3 billion and accounting for 16.3 percent of national health expenditures (NHE). Average spending per beneficiary in Medicaid was 1.4 times greater than spending on individuals with private health insurance. The chart below provides insight into where that money is going: a large share of the nation’s spending on nursing and retirement care, home health care, and other residential and community-based services are paid for by Medicaid.
As the nation marks the 50th Anniversary of the creation of Medicare and Medicaid, it is important to both look back at how the programs have evolved, as well as forward at what’s to come. But be careful—the trajectory may alarm you. Between 2010 and 2023, total expenditures on Medicare and Medicaid will more than double to nearly $2 trillion annually, while enrollment during that same period is only expected to increase by 45 percent. Spending on Medicare did not surpass $500 billion until 2009, 44 years after the program began; but it will only take 13 years beyond that to increase by the same amount. In the 10 years between 2014 and 2023, average annual enrollment growth in both Medicare and Medicaid will be approximately 3 percent, while average annual growth in expenditures will be more than double the rate of enrollment for both programs—6.2 percent for Medicaid and 7 percent for Medicare.
The Medicare program was established 50 years ago and, as of 2013, provided health care coverage to 52.3 million beneficiaries at a cost of $583 billion. Serving 19.4 million beneficiaries in 1967, total Medicare expenditures were $4.7 billion. The growth in program expenditures is largely due to growth in the number of beneficiaries. However, growth in health care prices and the availability of more health care services has been a significant factor in the growth of real per-beneficiary spending, which has tripled since 1970. Between 1965 and 2010, average annual growth in health care prices outpaced general price inflation by approximately 2 percent. Average total spending per beneficiary was $12,210 in 2013, and will continue to rise. As the number of beneficiaries will also soon skyrocket—enrollment is expected to grow at an average annual rate of 3 percent over the next decade, this combination will dramatically increase Medicare expenditures, expected to surpass $1 trillion by 2022.
In the 50 years since the Medicare program was signed into law, it has become the second-largest expenditure in the federal budget, costing $600 billion in 2014. Policymakers have become increasingly concerned recently with the expected growth of the Medicare-eligible population as the Baby Boomers begin to retire, at a rate of 10,000 per day, and the impact such growth will have on the program’s finances, and the federal budget. That concern is valid: in 20 years, the percent of the total U.S. population age 65 or older is expected to increase to 21 percent—a percentage-point increase more than double the growth among the elderly population in the first 50 years of the program. However, while the retirement of the Baby Boomers will bring a rate of growth unseen thus far, the beneficiary population has been steadily growing as a percent of the population since the program’s inception. In 1966, Medicare beneficiaries equaled 9.7 percent of the U.S. population; by 2013, 16.6 percent of the population was receiving Medicare benefits.
Historically, expenditures on retail prescription drugs has never far exceeded 10 percent of all spending on health care, and despite the recent wave of expensive drugs, is not projected to in the future.
The American Action Forum (AAF) recently assessed the plausible effects of a ruling for the plaintiffs in the Supreme Court case, King v Burwell, concerning the legality of subsidies in the federally-run health insurance exchanges implemented under the Affordable Care Act (ACA). One outcome of such a ruling would be that medium and large employers in the 37 states with federal exchanges would no longer be burdened with the ACA’s employer mandate. The employer mandate requires all employers with 100 or more “full-time” workers (50 or more effective 2016) to provide their employees with health insurance. AAF previously assessed the labor market effects of the mandate and other regulations, finding that they have already reduced employment and weekly pay. To make matters worse, the ACA defines “full-time” as working 30 or more hours per week, which is nowhere close to reality in today’s labor market. As a result, all employers with 100 or more workers this year and 50 or more next year must be conscious of all their workers’ hours if they wish to avoid the employer mandate.
The Centers for Medicare and Medicaid Services (CMS) recently released updated data that provides information on Medicare Part B physician services for the year 2013.1 Included in the data is an abundant wealth of information on physician charges and payments that reveal significant regional disparity in costs.
This week, the Center for Medicaid and Medicare Services released an update to enrollment figure that counts effectuated enrollment, which includes only households that have paid an insurance premium. As generally expected, roughly 15 percent of individuals with “plan selections” did not pay a premium and become actually enrolled.
In order to account for geographic variation in health care costs, insurance issuers are free to set different prices for across different locations.
Most people have a difficult time fully understanding their health insurance coverage, resulting in financial loss. The inability to accurately evaluate the various cost-sharing mechanisms leads many people to select a financially-dominated insurance plan—a plan which, given the premium and cost-sharing amounts, is economically suboptimal. For instance, spending $625 more in annual premium costs for a $500 lower deductible is economically irrational; yet, as shown below, the majority of people make that kind of mistake. A recent report analyzes the costs which result from these suboptimal choices. While people consider many factors besides cost when selecting health insurance, most of these preference differences were eliminated in this study and the problem persisted: 55 percent chose a financially-dominated plan. The average savings which could be achieved by switching from various dominated plans are shown.