Health Finance Issues

AT A GLANCE:

• According to a federal analysis released January, 2008, in 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D’s impact. Most of the other major health care services and public payers experienced slower growth in 2006 than in prior years.  (Health Affairs, 1/8/08) 

• By comparison, in 2005 U.S. health care spending increased 6.9 percent to almost $2.0 trillion, or $6,697 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than the 15.9 percent share in 2004. This third consecutive year of slower health spending growth was largely driven by prescription drug expenditures. Spending for hospital and physician and clinical services grew at similar rates as they did in 2004. (Health Affairs, 1/9/07)

• For 2008, price inflation appears to be the biggest element of overall medical plan trend, accounting for approximately 60 percent of overall projected preferred provider organization (PPO) trend in 2008. (Segal Survey, 2008)

According to a recent survey conducted by the Commonwealth Fund, 34% of U.S. adults ages 19 to 64 face problems with medical bills or have medical debt, although 62% of those individuals have health insurance. (12/7/07)

Medicaid Expenditures and Enrollment continue to be a dominent state concern and commitment. According to the latest analysis by the HHS/CMS Office of the Actuary (2008 Actuarial Report on the Financial Outlook for Medicaid):

•  Estimated average Medicaid enrollment was 49.1 million people in 2007. At some point during the year, 61.9 million people, or about one of every five persons in the U.S., were enrolled in Medicaid.

• Per-enrollee spending for health services was an estimated $6,120 in 2007. Per-enrollee spending for non-disabled children ($2,435) and adults ($3,586) was much lower than that for aged ($14,058) and disabled beneficiaries ($14,858), reflecting the differing health status of these groups.

• Expenditures for medical assistance payments represent about 94 percent of all Medicaid outlays and are projected to increase 7.3 percent to $339.0 billion in 2008. Over the next 10 years, expenditures on benefits are projected to increase at an average annual rate of 7.9 percent and to reach $673.7 billion by 2017.

Total Medicaid outlays in FY 2007 were $333.2 billion; $190.6 billion or 57 percent represented Federal spending, and $142.6 billion or 43 percent represented State spending.

There are thousands of publications, hundreds of professional, industry and advocacy organizations, and dozens of well-funded "think tanks" writing about health finances.

In the face of this activity, the National Conference of State Legislatures has concentrated its own resources on questions frequently asked by state legislators.

NCSL On-Line  

• Retail Health Clinics: State Legislation and Laws - This new NCSL Health Program report describes the growing trend of lower-cost, limited service in-store clinics, now operational in at least 1,175 locations.  Updated 4/09.

• Health Insurance: Premiums and Increases: Comparison Nationally and by State - 2004 - 2008.  Compiled by NCSL; posted 10/2008.

• Employer Tax Incentives to Offer Health Insurance - NCSL report, December 2008.

• Health Coverage Tax Credit Program (HCTC) - Description of state options under the 2002 federal law.  Added December 2008.

• Health Premiums by Insurance Type, 2007 - a graphic summary, adopted from Kaiser's survey.

• Health Savings Accounts: State Legislation 2004-2009 - Overview of state actions since the creation of HSAs, updated 4/09

  • Consumer-Driven Health Care, HSAs and States - PowerPoint by Richard Cauchi for NCSL Fiscal Analysts, 9/6/06.

• Innovation in Health Care: Some examples, 2006-2008, Richard Cauchi, NCSL Health Program Director - SLLF Leadership Summit 2008, June 6, 2008 - [ Presentation]
• Massachusetts Sets Out to Bend the Cost Curve  - NCSL State Health Notes article , 9/2/08. 
       Summary of MA S.2863 final version, "An Act to Promote Cost Containment, Transparency and Efficiency...". Sept. 2008.

• Health Care Costs & Spending: Latest State Strategies - Presentation by Richard Cauchi, NCSL for the Iowa Legislative Commission on Affordable Health Care Plans for Small Businesses and Families, 9/19/07. [ PDF 36 pages]

• State Legislation Relating to Transparency and Disclosure of Health and Hospital Charges - NCSL report on price transparency; reposted 11/09.

• Certificate of Need: State Health Laws and Programs - NCSL report, updated 4/09

• States and Small Business Health Insurance: An Overview  - NCSL report, updated 8/08.

• Health Care Provider and Industry Taxes and Fees - NCSL report with data from Fiscal Affairs Program, 9/08.

  • State Budget & Tax Actions 2007: Preliminary Report Special Fiscal Report by Corina Eckl and Ron Snell,  NCSL Fiscal Affairs Program.

• NCSL Legislative Summit, New Orleans  Health Committee Session Thursday, July 24, 2008     Can We Afford Our Healthcare? New Directions and Solutions

  CLICK TO VIEW    83 min.

  America spends an astounding $2.4 trillion to keep us alive, productive and healthy, a number that will rise by $175 billion this year. Some states want to take the lead in "fixing" key parts this system—a daunting task for big- and small-government experts alike. Hear three national experts discuss recent initiatives intended to control costs while preserving or improving health outcomes.
  • Moderator: Representative Dennis Richardson, Oregon House
  • Jeanne Lambrew, Associate Professor of Public Affairs, LBJ School, University of Texas; former Assistant Director for Health, OMB, White House. - [ Presentation]
  • Robert B. Helms, Resident Scholar & Director of Health Policy Studies, American Enterprise Institute; former Assistant Secretary, HHS, Washington, D.C - [ Presentation]
  • John Clymer, President, Partnership for Prevention, Washington, DC - [ Presentation]

• Health Committee Session Friday April 25, 2008: NCSL Spring Forum - Washington DC  - Covering High-Cost, High-Risk People:  Whose Responsibility?     State interest in both health "reform" and health cost savings creates special challenges for covering patients considered "high risk" and high cost. The sickest 10 percent of our population often cost tens of thousands of dollars annually, accounting for over 60 percent of U.S. health spending. Yet a cancer survivor may have low annual costs but be uninsurable. How should these people be treated by insurance market underwriting practices?  What are the roles of state-sponsored high-risk pools, the health insurance industry, government, providers and the high-cost individuals themselves in providing and paying for care?  Two national experts share facts and recent thinking. Presenters:  SESSION PODCAST - Listen here. Karen L. Pollitz, Project Director, Health Policy Institute, Georgetown University, Washington, DC - [ Presentation] Karen Ignagni, President and Chief Executive Officer, America’s Health Insurance Plans (AHIP), Washington, DC - [ Presentation] Facilitator: Representative Susan King, Texas House of Representatives

   

• Rising Health Insurance Costs and Changes: State Approaches - NCSL PowerPoint for Idaho Legislatures's Health Care Task Force, 7/11/07.

• "Collecting from the Uninsured: hospital billing practices" -NCSL LegisBrief by Kala Ladenheim, 7/06 [member password may be required]

• "State Financing: Resources and Guidance for Provisions in the Deficit Reduction Act Of 2005" - The DRA presents states with an opportunity to implement some of the Medicaid initiatives they otherwise would have been prohibited from trying.  Published 8/07. 

• Health Cost Containment - see the Balancing Health Needs with Resources series of eight papers, written by national experts over the past four years.  Copies are free to Legislators and staff, and available for purchase by others..  [password required]

• • "State Options for Expanding Health Care Access"- NCSL report by Barbara Yondorf and Laura Tobler, March 2004.

  • "Investing in Cost-Effective Health Service" This 5th NCSL paper discusses the challenge facing state legislators to balance provisions for individual health care with public health programs.  February 2004. 

  • "A Framework for Considering Health Cost Containment"- NCSL report by Barbara Yondorf, July 2003.
  • A Vision for a Compassionate and Affordable Health System
  • Aging in Place: State Policy Trends and Options (2005 - author: B. Yondorf, 35 pages)
  • Evidence-Based Medicine and State Health Policy
  • Spending Wisely: Promoting a More Rational Health Care System Through Better Benefit Design
  • The Oregon Experience: Prioritizing Services and Expanding Coverage

• State Employee Health Benefits- a one-stop web resource page, with statistics, links to states and premiums, and other experts, updated for 2009. 

• Health Care Reform and Finance by Professor Uwe Reinhardt - Plenary Session speech at NCSL Annual Meeting, August 19, 2005 in Seattle (80 slides in PDF | Audio Link | Video Link.

• State Pharmaceutical Assistance Programs - Health Program, updated regularly 2009

  

Additional, Non-NCSL On-Line Resources:

• Premiums versus Paychecks: A Growing Burden for Workers: Over the last eight years, health care costs have skyrocketed, while working families’ wages have stood still, putting a significant strain on family budgets. This series of state-specific reports examine what these trends mean for working families. | Press Releases 10/08

• 79 Million Americans Struggle to Pay Medical Bills. - New numbers show the problem is getting worse, not better, even for middle class By US News & World Report  8/20/08.

• 2008 Long-Term Care Cost of Care research report - Prudential Financial resource for consumers seeking information to help them make informed decisions about their long-term care needs. The study found an increase in the average cost of long-term care ranging from 5% to 13%, varying by type of service, in the past two years alone.  8/18/08.

• "Health care costs expected to rise 5.7% in '09"(article by USA Today 9/4/08)
  "Health benefit cost growth predicted to ease slightly in 2009 as employers shift cost." (Mercer release)  -  report released  by Mercer Health, 9/4/08.

• "Health care cost growth expected to slow" - A report released by Aon Consulting Worldwide estimates employers will spend about 10.6 percent more in 2009 for the same health benefit package they're offering this year.  San Francisco Chronicle, 8/12/08.

• 2009 Segal Health Plan Cost Trend Survey - a 6-page summary report of projected costs for the coming year; released August 2008.

• "Financing the U.S. Health System: Issues and Options for Change" - published by The Bipartisan Policy Center (BPC) and funded by the Robert Wood Johnson Foundation (RWJF).  [36 pages].  6/30/08.

• "The Distribution Of Public Spending For Health Care In The United States, 2002" - This July 2008 study shows that the public sector accounted for 56.1 percent of health spending within the civilian noninstitutionalized population. The analysis highlights this sector's role in financing the care of seniors and people in poor health. Health Affairs, web special, 7/29/08.
• "Surgical Errors Cost Nearly $1.5 Billion Annually"- AHRQ, 7/28./08.
• "While HMO Premiums Remain High, Rate of Increase to Decline in 2009", report released by Hewitt Associates, showing HMO premium rates will increase by approximately 11.8 percent in 2009—lower than last year's initial rate increases, but still on track to outpace inflation and underlying health care trends. 7/15/08.

•  "Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare" - CMS staff analysis as published in Health Affairs web article, 2/26/08.  

• "How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007" - The number of underinsured U.S. adults—that is, people who have health coverage that does not adequately protect them from high medical expenses—has risen dramatically, a Commonwealth Fund study finds. As of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003.  Health Affairs Web report, 6/10/08. [11 pages  PDF]
  > Charts, PowerPoint by Commonwealth Fund, 6/10/08.

• "What is the cost of Diabetes in your State" - According to the American Diabetes Association, the national cost of diabetes in the U.S. in 2007 exceeds $174 billion. This estimate includes $116 billion in excess medical expenditures attributed to diabetes, as well as $58 billion in reduced national productivity. An state-by-state online calculator posted by the American Diabetes Association.

• "Economic Costs of Diabetes in the U.S. in 2007" a print report with latest cost analysis by the American Diabetes Association, 5/08. 

• "Health Reform Through Tax Reform: A Primer" by Jason Furman, Brookings Institution, published in Health Affairs May/June 2008. [11 pages]

• "The cost of hospital care is difficult to pin down" - Philadelphia Inquirer, 6/8/08.

• New Brief Examines State Programs that Allow the Purchase of Private Insurance with Medicaid and SCHIP Funds - Premium assistance programs use federal and state Medicaid and State Children’s Health Insurance Program (SCHIP) funds to purchase private coverage. Overall, few states have such programs, but interest in the approach remains high. Kaiser Family Foundation.

• Improving the value and cost of US health benefits: Could shifts in the employer role provide the solution? - An overview from Mercer, the commercial benefits advisory company.  1/25/08.

• 2008 Segal Health Plan Cost Trend Survey.  Projected declines reflect 5th year of lower medical trends. "Surprisingly, trends for prescription drug coverage are projected to decelerate most - to levels similar to trends for medical coverage for the second consecutive year. Prescription drug projected trends have declined dramatically, by nearly nine percentage points, since their high of 19.5 percent in 2003."  Published 11/07.  PDF

• National Health Expenditures (NHE) Projections 2007-2017, Forecast summary and selected tables - CMS Office of the Actuary [PDF, 18 pages] posted 1/08.

• Taxes and Health Insurance: Analysis and Policy - An Economic Studies and Urban-Brookings Tax Policy Center Event, 2/29/08.

• "Rate of Increases for U.S. Health Care Costs Declines for Fifth Consecutive Year." For 2008, Hewitt forecasts that companies will receive cost increases of 9.0 percent for traditional indemnity plans, 8.5 percent for POS plans, 9.0 percent for HMOs, and 8.5 percent for PPOs. That means from 2007 to 2008, the average cost per person for major companies will increase from $7,957 to $8,673 for HMOs; $7,790 to $8,452 for PPOs; $8,573 to $9,302 for POS plans; and $9,277 to $10,112 for indemnity plans. 9/24/07.

• Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits. The latest in a series of AHIP surveys shows that the market for individually purchased coverage is more affordable and accessible than may be widely known. Published by America's Health Insurance Plans, 12/19/07.

• New England And Mideast Region Spend The Most On Health Care - report by the CMS Office of the Actuary,  Health Affairs Web Exclusive, 9/18/07.

• "Saving on Health Care" - 10 practical consumer tips; report by ABC Action News, 11/8/07.

• The Long-Term Outlook for Health Care Spending- with projections out to 2082; report by the Congressional Budget Office, 11/07.

• An Overview of the U.S. Health Care System: Chart Book. Published by Centers for Medicare and Medicaid Services and Office of the Assistant Secretary for Planning and Evaluation, HHS, 1/31/07. 

• Employer Health Benefits 2007 Annual Survey- This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including changes in premiums, employee contributions, cost-sharing policies, and other relevant information.  Versions: News Release | Summary of Findings | Chart Pack | Cost of Health Insurance (Sec. 1) | 
  Researchers at the Kaiser Family Foundation, The Center for Studying Health System Change and Health Research and Educational Trust designed and analyzed the survey.  Published 9/11/2007.

• Fact Sheet Explores Health Care Costs Kaiser issued a new fact sheet presenting key statistics about the growth, level and impact of rising U.S. health care costs. 9/07.

• Health Spending Projections Through 2016: Modest Changes Obscure Part D’s Impact.  Over the next decade, U.S. health care spending is expected to double from today’s level, reaching $4.1 trillion and consuming almost twenty cents of every dollar spent, federal forecasters report in an article published in Health Affairs Web Exclusive. Health spending in 2006 is projected at $2.1 trillion, which accounts for 16 percent of the gross domestic product. The average annual growth in health care spending is projected to remain relatively steady at 6.9 percent from 2006 through 2016.  (Health Affairs, 2/21/07) (subscription required)

  • Last Year of Life Study: Costs  -CMS study, using data from 1993-2000. [PDF, 596 KB]

• "National Health-Care Spending in 2005: the Slowdown Continues" - Health-care spending in 2005 grew at the slowest rate since 1999, rising 6.9 percent to nearly $2 trillion. This rate is down from a 7.2 percent rise in 2004 and an 8.1 percent increase in 2003. The slowdown in expenditures is due largely to a sharp decrease in spending on prescription drugs, which itself was caused by a sharp decline in Medicaid drug spending, changes in drug therapy regimens, tiered copayment benefit plans and increased use of generics. Health-care spending in 2005 accounted for 16 percent of the gross domestic product, or $6,697 per person. The year 2005 also marked the third year in which health insurance premiums climbed more slowly. Despite the slowdown in spending, the percentage of personal income devoted to health care is rising. And while prescription drug spending slowed, spending for hospital, physician and clinical services in 2005 grew at rates similar to those of 2004. The report is issued annually by the Centers for Medicare & Medicaid Services; published in Health Affairs, 1/9/07. (subscription required)

• "Behind the numbers: Healthcare cost trends for 2008"  Based on discussions with private insurers, medical costs are expected to rise by 9.9% for preferred provider organizations (PPOs), 9.9% for health maintenance organizations (HMOs)/point of service plans (POSs)/exclusive provider organizations (EPOs), and 7.4% for consumer-directed health plans. PricewaterhouseCoopers Health Research Institute, 6/07. [PDF 20 pages; Free registration required]

• "Is Health Spending Out of Control?" brief by National Center for Policy Analysis, 5/17/07. 2 pages 

• "Health Care Costs 101", an annual overview of the latest health spending trends, offers reasons for both hope and concern. Health spending increased by 6.9% in 2005, continuing a trend of moderating increases. Yet, the increase is still double the rate of inflation.   Among the key findings: 1) Hospitals and physician services take the largest share of the health care dollar (52%); 2) Prescription drug increases are at their lowest levels in 20 years; and 3) While out-of-pocket costs for consumers continue to rise, as a share of all personal health care spending (15%), the percentage has declined.  Published by CA Health Care Foundation, 4/07. [ PDF, 24 pages]

• California Employer Health Benefits Survey, 2007, online survey results, a joint project of the California HealthCare Foundation and the National Opinion Research Center.  12/17/07.

• Health Care Community Benefits: A Compendium of State Laws - Community Catalyst, 2003

• The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults - analysis of Medicare data by the Kaiser Family Foundation. 9/07.

• Tracking Health Care Costs: Continued Stability But At High Rates In 2005 - by the Center for Studying Health System Change; in Health Affairs online 10/3/06.

• Abstract of 2007 Segal Health Plan Cost Trend Survey - by Segal & Co, 12/06  

• Snapshots: Health Care Costs is a series of online publications written by Kaiser staff that use charts, data and analysis to provide insight into the political and policy debates about the cost of health care in the United States.
  Insurance Premium Cost-Sharing and Coverage Take-up, February 2007
  Health Care Spending in the United States and OECD Countries, January 2007
  Illustrating the Potential Impacts of Adverse Selection on Health Insurance Costs in Consumer Choice Models, November 2006
  Comparing Projected Growth in Health Care Expenditures and the Economy, May 2006
  Distribution of Out-of-Pocket Spending for Health Care Services, May 2006

• "CONSENSUS: AMERICANS WANT HEALTH CARE FOR ALL"  - Citizens’ Health Care Working Group (CHCWG) created by federal law releases Health Care Recommendations to Congress and the President.  Media release, 9/06.

• Milliman Survey Foresees 2007 Lowest Health Insurance Rate Increase in 7 Years - The 2007 estimated January renewal increase of 9.7% for Health Maintenance Organizations (HMOs) is 0.9% lower than last year’s survey result of 10.6%, and down 7% from four years ago. Preliminary results for Preferred Provider Organizations (PPOs) show an anticipated 2007 renewal rate increase of 10.7%, or 1.0% lower than last year but 1.0% higher than HMOs.   News release, 7/18/06. [2 pages ]

• "Update 2006: Why Are Health Costs Rising?" A market-based perspective brief by National Center for Policy Analysis, 9/21/06. [2 pages ]

• Minnesota Hospitals: Uncompensated Care, Community Benefits, and the Value of Tax Exemptions - This report to the Minnesota legislature analyzes data on uncompensated care, community benefits, and the value of tax exemptions at Minnesota hospitals. It makes recommendations about the need for more uniform charity care and debt collection policies, and the need for uniform reporting of nonprofit hospitals' community benefits." -MN Dept of Health, 1/07.

• Wellness Programs for Retirees Found to Drive Significant  Healthcare Cost Savings, report by Thomson-Medstat, 11/15/06.

• Medicaid at a Turning Point: Results From a 50-State Survey on State Budgets and Medicaid Policy Actions for Fiscal Years 2006 and 2007 - Kaiser Commission on Medicaid and the Uninsured, 10/10/06

• Hewitt Offers Employees Tips on Maximizing Benefits Dollars During Open Enrollment Season - Hewitt Associates release 9/26/06 [3 pages] 

• Fighting Medicare Fraud Using Whistleblower Statute Returns $15 for Every $1 Invested - Taxpayers Against Fraud, 7/06. [12 pages ]

• Creating Pay-for-Performance Without Breaking the Bank - Segal & Co., 7/06.

  • Pay for Performance– Editorial by Managed Care Quarterly - 8/1/06

  • "Pay-for-Performance Concept Gaining Traction in Healthcare", Survey by Thomson Medstat Conference Showcases Successful Efforts to Manage Healthcare Costs Across Industry Sectors, released 4/26/06.

  • Pay For Performance: Summit Conference in February 2006 examines this recent trend.

• Total Health Management: The Future of Health Care Cost Management? - Chris Mathews, Segal & Co., 7/06.

• "California Hospitals: Coverage and Cost" - excerpt of an innovative online database on hospital quality. Posted by the CA Healthcare Foundation, 4/07.

• Higher Premiums for Those with Unhealthy Lifestyles Supported by 53 Percent of U.S. Adults, According to Poll - Harris Interactive, 7/31/06.

• Average Couple Today Needs $295,000 for Retiree Health Expenses - EBRI report 7/20/06.  

• Snapshot: Health Care Costs 101, 2006 Edition   by the California HealthCare Foundation. April 2006. [24 pages]

• 2006 Segal Health Plan Cost Trend Survey  PDF | Abstract |-  forecasts continued declines in trends in 2006 compared to 2005 for almost every coverage surveyed. -published 2/06.

• HMO Rate Increases Continue to Decline for Fifth Consecutive Year, by Hewitt Associates, released 9/06.

• "How to Create a Competitive Insurance Market,"  National Center for Policy Analysis, Brief Analysis No. 558,  6/15/06.  

• National Health Expenditures: Historical - 1995-2004 detailed statistics published by the CMS Office of the Actuary.

• The Pennsylvania Community Health Reinvestment Agreement: Establishing Non-Profit Insurers’ Community Benefit Obligations - The Access Project/SCI, 8/06.

• "Trends: National Health Spending In 2004: Recent Slowdown Led By Prescription Drug Spending"  with 10 year comparative statistics, by the CMS National Health Accounts Team , published in Health Affairs, Jan/Feb 2006. (subscription required)

• Capturing Value: Increasing Efficiency in Healthcare, NIHCM Foundation, March 2006. This Meeting Brief examines national variations in health care outcomes. A small group of health policy thought leaders were invited to discuss ways to change the efficiency equation- the ratio of spending to outcomes.

• Employers Expect Rate of Increase in Health Benefit Costs to Slow in 2006 report by Watson Wyatt, National Business Group on Health Survey results, 2/15/06.  [Full survey to be released 3/06]

• Employer Health Benefits 2005 Annual Survey - Published 9/14/05.  (See 2006 Edition, above) 

  • Cost of Health Insurance, 2005 (Sec. 1; 16 pages) 
  • Employee Coverage, Eligibility, and Participation, 2005 (Sec. 3; 9 pages)
  • High-Deductible Health Plans and HSA Options, 2005 (Sec. 8, 12 pages)
• Milliman 2005 Group Health Insurance Survey Sees Slowing of Premium Increases Results from Milliman' s fourteenth annual survey of Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) indicate a slowing of premium increases. Among plans responding in both 2004 and 2005 for the benefit plan provided, 2005 HMO premiums increased 8% over 2004, the lowest increase in five years.  10/24/2005.

• Specialty Hospitals, Price Competition and the Medical Arms Race | PDF full text] - Purchasers in Three Communities View Specialty Hospitals as Spurring Medical Arms Race - released by Center for the Study of Health Systems Change, 1/25/06.

• Specialty Hospitals: A Problem or a Symptom? (Health Affairs, Jan./Feb. 2006)- analysis of two congressionally mandated reports on specialty hospitals. Those reports find that specialty hospitals appear to provide high quality while offering popular amenities to their patients, but also tend to treat more profitable Medicare patients and fewer Medicaid and uninsured patients than community hospitals in the same markets.
• Health Spending in the United States and the Rest of the Industrialized World, by Gerard F. Anderson of Johns Hopkins University and colleagues, compares health spending in the United States with 30 industrialized nations, 7/05.

National Health Expenditures (2007 = $226 Trillion)		Employers’ Median Annual Health Care Benefit $ Increase (for current employees) (c) 2006 Watson Wyatt

Older but Useful On-Line Resources:

• 2002–2003 State Health Expenditure Report - Using latest data available in 2005; Co-Published by the Milbank Memorial Fund, the National Association of State Budget Officers, and the Reforming States Group, 6/05 [88 pages]
  

• The Rising Prevalence Of Treated Disease: Effects On Private Health Insurance Spending - published as a Health Affairs web exclusive 6/29/05  [PDF, 9 pages].

• Health Costs Absorb One-Quarter of Economic Growth, 2000 – 2005 Health Reform Program, Boston Univ. School of Public Health 2/05.

  "Top Five Total Rewards Priorities for 2005": A Survey of Certified Employee Benefit Specialists. For the sixth consecutive year, benefit specialists have identified the issue of controlling the cost of health care benefits as their Number One benefit priority. Deloitte, April 2005.

• State Health Facts by Kaiser Family Foundation - a 50-state database including costs and budgets, 2005 edition
  • Total State Health Care Expenditures as % of the Gross State Product, 2004
  • Average Annual Percent Growth in Personal Health Care Expenditures, 1980-2000
  • State Health Care Expenditures (in millions), 2003
  • Average Annual Cost of Employment-Based Health Insurance--Single Coverage, 2004
  • Average Annual Cost of Employment-Based Health Insurance--Family Coverage, 2004
• Examining Pay-for-Performance Measures and Other Trends in Employer-Sponsored Health Care, by Meredith Rosenthal, The Commonwealth Fund, May 2005 -
• "Electronic Health Records: Just around the Corner? Or over the Cliff?" - Annals of Internal Medicine, 8/2/05. 
  A study estimates that building an NHIN over five years would require $156 billion in capital investment, plus $48 billion in annual operating costs. These amounts total only a small part of the $1.65 trillion spent on health-care each year.
• Health Spending Projections Through 2013 - Health Affairs web exclusive, 2/11/04
  • Summary of Health Spending Projections- by CMS Actuaries as reported by Commonwealth Fund, 2/11/04
• Employer-Sponsored Health Insurance in New York, by The Commonwealth Fund, 5/04 [8 pages] 
• Risky Business: When Mom and Pop Buy Health Insurance for Their Employees. by The Commonwealth Fund, 4/04.
• 2004 Segal Health Plan Cost Trend Survey by The Segal Company's is available online as of 12/2/03.