"The federal government’s share of most Medicaid expenditures is established by the federal medical assistance percentage (FMAP) rate, which generally is determined annually and varies by state according to each state’s per capita income relative to the U.S. per capita income.49 The formula provides higher FMAP rates, or federal reimbursement rates, to states with lower per capita incomes, and it provides lower FMAP rates to states with higher per capita incomes."FMAP rates have a statutory minimum of 50% and a statutory maximum of 83%.50 For a state with an FMAP of 60%, the state gets 60 cents back from the…
Total National Health Expenditures in the US
"NHE [National Health Expenditures] increased by 3.9 percent in 2017 to $3.5 trillion or $10,739 per capita. This growth rate is lower than what was observed in 2016 (4.8 percent) and 2015 (5.8 percent). After a period of relatively fast growth in 2014 and 2015 during the implementation of the Affordable Care Act (ACA), 2017 was characterized by slower growth that continued from 2016. In fact, growth in 2017 was similar to the 3.7 percent average annual rate of the 5-year period ending in 2013. These growth rates are the lowest since the early 1960s when health spending was first…
Total Health Care Spending in the US by Type
"Exhibit 1 decomposes health care spending in 2017 by type of expenditure. In this breakdown, health spending can go towards investment or HCE [Health Consumption Expenditures]. Investment accounted for $167.6 billion (or 4.8 percent of total health spending). The remainder went to the HCE category, which CMS divides into spending on personal health care, government public health activities, government administration, and the net cost of health insurance."The bulk of the HCE category is made up of personal health care spending, which was $2,961 billion or 84.9 percent of total health spending in 2017. The four main categories of personal health…
Total Healthcare Spending In the US by Sponsor
"PHI [Private Health Insurance] spending was to $1,183.9 billion in 2017. Through employer contributions to employer sponsored health insurance premiums, private businesses financed 45.3 percent ($536.3 billion) of PHI spending - the largest contribution among sponsors. Households were the second largest sponsor of PHI spending, financing 31.5 percent ($372.4 billion) of PHI spending through employee contributions to employer-sponsored health insurance premiums (23.5 percent), household contributions to direct purchase insurance (4.6 percent) and the medical portion of property and casualty insurance (3.4 percent). The government had the smallest contribution to PHI spending with state and local governments financing 16.2 percent ($192.3…
Total Healthcare Spending In the US by Funding Source
"PHI [Private Health Insurance] had the largest share of total health spending at 33.9 percent ($1,183.9 billion), as has been the case for the past four decades (Kane, 2017). Medicare spending accounted for 20.2 percent of total health spending ($705.9 billion) and Medicaid spending made up 16.7 percent ($581.9 billion). Out-of-pocket spending, which includes all payments made directly by all patients regardless of insurance status, was 10.5 percent of total health spending ($365.5 billion). Spending on other health insurance programs was 3.8 percent of total health spending ($132.6 billion) and spending on other third-party payers and programs and public health…
How People With Pre-Existing Conditions Were Handled By Insurers Prior to Passage of the ACA
"Before the ACA, individual insurers in the vast majority of states could collect information on demographic characteristics and medical history, and then deny coverage, charge higher premiums, and/or limit benefits to individuals based on pre-existing conditions. An industry survey found that 34 percent of individual market applicants were charged higher-than-standard rates based on demographic characteristics or medical history.4 Similarly, a 2009 survey found that, among adults who had individual market coverage or shopped for it in the previous three years, 36 percent were denied coverage, charged more, or had exclusions placed on their policy due to pre-existing conditions.5 A report…
Impact of the ACA on Health Insurance Coverage for People with Pre-Existing Conditions
"• Up to 133 million non-elderly Americans—just over half (51 percent) of the non-elderly population—may have a pre-existing condition. This includes 67 million women and girls and 66 million men and boys. "• The likelihood of having a pre-existing condition increases with age: up to 84 percent of those ages 55 to 64—31 million individuals—have at least one pre-existing condition. "• Among the most common pre-existing conditions are high blood pressure (46 million people), behavioral health disorders (45 million people), high cholesterol (44 million people); asthma/chronic lung disease (34 million people), heart conditions (16 million people), diabetes (13 million people),…
Financial Impact of the ACA on Safety Net Hospitals
"Patient service revenue grew. Largely linked to the growth in patient volumes from insured patients, operating revenues increased for expansion state hospitals (by an average of 17 percent) and, to a lesser extent, for non-expansion state hospitals (11 percent on average) between 2013 and 2015. For expansion state hospitals, this increase came largely from Medicaid. Revenue growth was especially large for the study hospitals that receive cost-based Medicaid reimbursement (for at least some patients and/or services) from their states; these hospitals include the rural critical access hospitals and LAC+USC (Appendix 2). For others, Medicaid reimbursement is less than the costs…
Effects of the ACA on Safety Net Hospitals
"Study hospitals (Appendix 2) in states that expanded eligibility for the Medicaid program experienced considerable patient volume increases from Medicaid enrollment expansions, whereas they experienced little volume change from the ACA’s expansion of commercial coverage through the federal and state Marketplaces. Despite concerns that they might lose many newly insured patients to other providers, these study hospitals largely retained existing patients and gained new ones. The growth in patient volume was especially notable for outpatient care, and there were corresponding marked increases in the proportion of their patients with insurance coverage. The growth in outpatient visits reflects in part safety…
Health Insurance Coverage By Type In The US
"In 2017, most people (91.2 percent) had health insurance coverage at some point during the calendar year (Table 1 and Figure 1). More people had private health insurance (67.2 percent) than government coverage (37.7 percent).10"Employer-based insurance was the most common subtype of health insurance in the civilian, noninstitutionalized population (56.0 percent), followed by Medicaid (19.3 percent), Medicare (17.2 percent), direct-purchase insurance (16.0 percent), and military health care (4.8 percent) (Table 1)."The percentage of people covered by any type of health insurance in 2017 was not statistically different from the percentage in 2016. The percentage of people covered by private health…