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Health Finance Issues

 Updated: September 12, 2008


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AT A GLANCE:
Health Care in the United States is a $2.39 trillion industry in 2008, encompassing significant portions of federal, state and local budgets, as well as a huge private sector market. The issues of growth, inflation, prices, sources of funding, as well as coverage and quality of services are central to much of today's health policy discussion.  From Consumer-Driven Health to universal coverage, the state (and federal) debate has intensified in 2007-2008.  The following are a few overview statistics and projections, including some new, potentially conflicting projections by national experts:

  • 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)
  • In 2005, U.S. employers spent $596.5 billion on health benefits, up from $399.6 billion in 2000. Health benefits, which are taking an ever-increasing share of employers’ benefits spending, accounted for 44 percent of employer spending on benefits in 2005, up from 42 percent in 2000 and just 14 percent in 1960. (EBRI survey, 1/3/07)
  • 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)
  • According to an October 2006 survey, Americans are increasingly uneasy about high health care costs and are uncertain of their families' ability to afford health insurance, according to the Health Care in America 2006 Survey. The telephone survey of 1,201 Americans was conducted in September by the Henry J. Kaiser Foundation, ABC News, and USA Today. 80% of respondents said they are dissatisfied with the total cost of health care in the US, which is expected to hit $2.2 trillion in 2006.  Underscoring America's sense of unease, the survey found that 6 in 10 Americans with insurance are worried about their ability to afford coverage over the next 5 years. 
  • Premiums for employer-sponsored health coverage rose an average 7.7 percent in 2006, less than the 9.2 percent increase recorded in 2005 and the recent peak of 13.9 percent in 2003.  This year’s survey recorded the slowest rate of premium growth since 2000, though premiums still increased more than twice as fast as workers’ wages (3.8 percent) and overall inflation (3.5 percent). Premiums have increased 87 percent over the past six years. Family health coverage now costs an average $11,480 annually, with workers paying an average of $2,973 toward those premiums, about $1,354 more than in 2000. (from 2006 Employer Health Benefits Survey, 9/26/06).

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 Legislative Summit, New Orleans  - New item
Health Committee Session Thursday, July 24, 2008  

Can We Afford Our Healthcare? New Directions and Solutions  
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VIEW
Video 
 83 min.
 2008 NCSL meeting
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. - [Adobe PDF Presentation]
  • Robert B. Helms, Resident Scholar & Director of Health Policy Studies, American Enterprise Institute; former Assistant Secretary, HHS, Washington, D.C - [Adobe PDF Presentation]
  • John Clymer, President, Partnership for Prevention, Washington, DC - [Adobe PDF Presentation]

Innovation in Health Care: Some examples, 2006-2008, Richard Cauchi, NCSL Health Program Director - SLLF Leadership Summit 2008, June 6, 2008 - [Adobe PDF Presentation]

Massachusetts Sets Out to Bend the Cost Curve  - NCSL State Health Notes article , 9/2/08. New item
     Summary of MA S.2863 final version, "An Act to Promote Cost Containment, Transparency and Efficiency...". Sept. 2008.

NCSL On-Line Resources:

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Additional, Non-NCSL On-Line Resources:

The following is a selected list of some of the more recent or state-oriented reports from government, policy and academic sources. 
NCSL is not responsible for the content of publications and websites published by third parties and listed on this page.

RECENT REPORTS OF INTEREST

"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 pagesAdobe PDF].  6/30/08.New item

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

"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. New item

"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.New item


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  8/20/08New item

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.New item

"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.New item

"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.New item
 

 "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. Adobe PDF 

"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 Adobe PDF 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.

 

 National Health Expenditures
(2007 = $226 Trillion)

 

 Employers’ Median Annual Health Care Benefit $ Increase
(for current employees) (c) 2006 Watson Wyatt

Natl. Health Expenditures 2004-2017

   Health cost increases 2003-06

 

Older but Useful On-Line Resources:

2 - Employer Survey, 2003 by Deloitte & Touche, Sept 2003  Overall U.S. health care spending climbed to $1.6 trillion in 2002, or $5,440 per person.

Information compiled by Richard Cauchi, NCSL Health Program, Denver.

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NOTE: NCSL provides links to other Web sites from time to time for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site. Links to news articles more than two weeks old may no longer be active.  You may report broken links by email at  health-info@ncsl.org

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