Bethesda, MD—New estimates released today from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) project an average rate of national health spending growth of 5.6 percent for 2016–25, outpacing average projected growth in gross domestic product (GDP) by 1.2 percentage points. As a result, the health share of the economy is projected to climb to 19.9 percent by 2025—up from 17.8 percent in 2015. These projections are constructed using a current-law framework and do not assume potential legislative changes over the projection period.
Growth in national health spending is expected to be driven by projected increases in medical prices from a recent historic low of 0.8 percent in 2015, to nearly 3.0 percent by 2025. Growth in the use and intensity of medical services, however, is projected to slow relative to that experienced in 2014 and 2105, as the impacts of the Affordable Care Act’s coverage expansion wane and enrollment growth in Medicaid and private insurance slows. Changes in the age and sex distribution of the population are projected to consistently put upward pressure on growth throughout the projection period, contributing an average of about 0.5 percentage point to growth per year.
Every year the CMS Office of the Actuary releases an analysis of how Americans are expected to spend their health care dollars in the years ahead. The projected average growth rate for 2016-25 (5.6 percent) reflects the latest expectations from the Office of the Actuary and updates its 2016 report, published last year in Health Affairs.
The new findings appear as a Health Affairs Web First article; the study link will be:
http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2016.1627
The study will also be published in the journal’s March 2017 issue, to be released Monday, March 6, at 4:00 p.m. ET.
“After an anticipated slowdown in health spending growth for 2016, we expect health spending growth to gradually increase as a result of faster projected growth in medical prices that is only partially offset by slower projected growth in the use and intensity of medical goods and services,” says Sean Keehan, the study’s first author. “Irrespective of any changes in law, it is expected that because of continued cost pressures associated with paying for health care, employers, insurers, and other payers will continue to pursue strategies that seek to effectively manage the use and cost of health care goods and services.”
The first two years of the projection period are expected to have the slowest health spending growth rates (4.8 percent in 2016 and 5.4 in 2017), as Medicaid and private health insurance spending growth slow and Medicare spending growth remains low. For 2018 and beyond, Medicare and Medicaid expenditures are expected to grow faster than in the 2016-17 period, and more rapidly than private health insurance spending. Keehan and his coauthors site several reasons for this. First, the use of Medicare services is expected to increase from its recent historical lows. Second, the Medicaid population mix will trend more toward older, sicker, and more costly beneficiaries. Third, baby boomers will continue to age into Medicare, with some dropping private insurance as a result. And finally, growth in the demand for health care for those with private insurance is expected to slow as enrollees face gradually rising relative health care prices and slowing income growth.
Here is a chronological look at projected trends, based on the current-law framework:
2016
- National health spending is projected to have grown 4.8 percent in 2016, compared to 5.8 percent in 2015, and to have reached nearly $3.4 trillion dollars.
- The uninsured population is expected to have declined again in 2016, by 1.2 million (to 28 million), driven primarily by increases in the numbers of people with employer-sponsored insurance and Medicaid.
- Medicaid spending growth is expected to have greatly decelerated, from 9.7 percent in 2015 to just 3.7 percent in 2016, driven in part by the expectation of slower enrollment growth. In contrast, Medicare spending growth is projected to have accelerated, but to have remained low relative to its historical average growth (reaching 5.0 percent in 2016, up from 4.5 percent in 2015).
- The largest projected slowdown in 2016 among the major goods and services sectors is prescription drug spending, which is projected to have grown just 5.0 percent in 2016, down from 9.0 percent in 2015. This slowdown can largely be attributed to the decrease in use of drugs to treat hepatitis C.
2017
- National health spending growth is projected to accelerate to 5.4 percent in 2017, up from 4.8 percent in 2016.
- From a payer perspective, Medicare spending growth is projected to accelerate in 2017 to 5.9 percent (from 5.0 percent in 2016), due to spending associated with physician and clinical services and hospital services for Medicare beneficiaries.
- Private health insurance spending growth is also expected to accelerate, to 6.5 percent in 2017 up from 5.9 percent in 2016, in large part because of premium growth for Marketplace plans due to underpricing of premiums in past years and the elimination of risk corridor payments.
2018–19
- National health spending growth is projected to accelerate from 5.4 percent in 2017 to an average of 5.9 percent for 2018–19, driven primarily by faster growth in Medicare and Medicaid.
- Medicare spending is expected to average 7.1 percent for 2018–19 (up from 5.9 percent in 2017), with the expectation that the use and intensity of medical services will increase to rates that are more consistent with Medicare’s longer-term historical experience. As a result, Medicare per enrollee average spending growth is projected to increase from 3.0 percent in 2017 to an average of 4.1 percent in 2018–19.
- Medicaid spending growth is also projected to accelerate—largely due to projected growth in the use and intensity of care needed for Medicaid’s increasingly larger proportion of older and disabled enrollees (up from 3.7 percent projected increase in 2017 to an expected average of 5.9 percent for 2018–19).
- Prescription drug spending growth is anticipated to accelerate from 5.7 percent in 2017 to an average of 7.0 percent for 2018–19, driven by faster price growth as a result of fewer brand-name drugs losing patent protection.
2020–25
- During 2020–25, national health expenditure growth is projected to rise at an average rate of 5.8 percent, similar to the average growth rate for 2018–19 of 5.9 percent, and still more rapidly than growth in GDP. These trends result in a projected increase in the health share of the economy to 19.9 percent in 2025.
- Medicare spending is projected to grow at an average rate of 7.6 percent in 2020–25 due to strong enrollment growth from baby boomers and the aging of the existing Medicare population.
- Average growth in Medicaid spending for this period (5.9 percent) is similar to that projected for 2018–19 and roughly the same as total health spending growth.
- Private health insurance spending growth is expected to decelerate (from 5.7 percent for 2018–19 to 5.0 percent for 2020–25), in a lagged response to slower growth in disposable personal income toward the end of the projection period and the expected implementation of the excise tax on high-cost insurance plans starting in 2020.
- Average annual medical price growth is projected to gradually rise, from 2.4 percent for 2018–19 to 2.7 percent for 2020–25.
- By 2025, 47 percent of health spending is projected to be sponsored by federal, state, and local governments, up from 46 percent in 2015. This expected higher share of spending by governments reflects, in part, the continued transition of the baby-boomer generation into Medicare. In contrast, the projected share of health spending sponsored by businesses and households in 2025 is expected to fall one percentage point, from 54 percent in 2015 to 53 percent in 2025.
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