Chart 1: Trends in National Health Expenditures (NHE) as a Share of Gross Domestic Product (GDP),

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1 Chart 1: Trends in National Health Expenditures (NHE) as a Share of Gross Domestic Product (GDP), Year Percent Change Gross Domestic Product (GDP) Percent Change National Health Expenditures National Health Expenditure as a Share of GDP % % 6.8% 5.4% % 9.2% 5.4% % 8.8% 5.6% % 11.0% 5.8% % 8.9% 5.8% % 10.2% 5.9% % 11.9% 6.2% % 13.5% 6.5% % 12.7% 6.7% % 13.0% 7.2% % 11.2% 7.4% % 11.9% 7.5% % 11.0% 7.5% % 13.3% 7.8% % 14.0% 8.2% % 14.5% 8.4% % 13.7% 8.6% % 12.4% 8.5% % 13.4% 8.7% % 15.4% 9.2% % 16.0% 9.5% % 12.8% 10.3% % 10.2% 10.4% % 10.2% 10.3% % 9.4% 10.5% % 7.3% 10.7% % 8.9% 11.0% % 12.1% 11.4% % 11.3% 11.8% % 11.9% 12.5% % 9.3% 13.2% % 8.4% 13.5% % 7.4% 13.8% % 5.6% 13.7% % 5.6% 13.9% % 5.3% 13.8% % 5.6% 13.7% % 5.8% 13.7% % 6.4% 13.8% % 7.0% 13.8% % 8.5% 14.5% % 9.5% 15.4% % 8.4% 15.9% % 7.1% 16.0% % 6.8% 16.1% % 6.6% 16.2% % 6.2% 16.4% % 4.7% 16.8% % 3.8% 17.9% % 3.9% 17.9% Centers for Medicare and Medicaid Services (2012), NHE by type of service and source of funds, CY , NHE60_10_Final.csv. Retrieved from: Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

2 Chart 2: Trends in Health Care Spending, by Source of Funds, Year Private Business US Dollars (in Billions) Federal Households Government State Government 1990 $178.3 $253.0 $125.3 $ $192.1 $268.9 $146.5 $ $207.6 $279.2 $172.3 $ $220.3 $290.9 $193.7 $ $231.1 $301.5 $205.0 $ $243.6 $319.0 $217.2 $ $260.3 $329.9 $231.8 $ $268.5 $354.7 $240.4 $ $289.1 $383.9 $236.4 $ $315.6 $406.1 $245.2 $ $346.3 $434.3 $261.0 $ $372.0 $457.2 $306.3 $ $399.7 $494.3 $347.4 $ $432.6 $528.7 $388.8 $ $459.1 $561.4 $425.1 $ $487.7 $596.7 $451.8 $ $502.4 $633.3 $498.1 $ $523.5 $668.9 $529.8 $ $531.4 $703.1 $582.4 $ $529.8 $705.5 $684.0 $ $534.5 $725.5 $742.7 $421.1 Notes: Spending unadjusted for inflation. Household spending includes premiums and out-of-pocket spending. Federal/state spending includes employer premiums, excludes Medicare Hospital Insurance Trust Fund support. Centers for Medicare & Medicaid Services (2012), NHE by type of service and source of funds, CY , NHE60_10_Final.csv. Retrieved from Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/

3 Chart 3: Trends in Shares of Health Care Spending, by Source of Funds, Year Private Business Shares of Total Health Care Spending Households Federal Government State and Local Government % 37.9% 18.8% 16.6% % 36.8% 20.0% 16.9% % 35.3% 21.8% 16.7% % 34.2% 22.8% 17.1% % 33.6% 22.8% 17.9% % 33.7% 22.9% 17.7% % 33.1% 23.3% 17.5% % 33.8% 22.9% 17.7% % 34.7% 21.4% 17.8% % 34.5% 20.8% 17.9% % 34.2% 20.6% 17.9% % 33.0% 22.1% 18.1% % 32.5% 22.9% 18.3% % 32.1% 23.6% 18.1% % 31.8% 24.0% 18.2% % 31.6% 23.9% 18.6% % 31.5% 24.8% 18.7% % 31.5% 24.9% 19.0% % 31.5% 26.1% 18.5% % 30.3% 29.4% 17.6% % 29.9% 30.6% 17.4% Centers for Medicare & Medicaid Services (2012), National health expenditure data. NHE by type of service and source of funds, CY , NHE60_10_Final.csv. Retrieved from Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/

4 Chart 4: Trend in Business Health Care Expenditures per Employee, Year Unadjusted Business Health Care Expenditures per Employee (2008 US Dollars) Workers' Compensation and Temporary Disability Insurance and Industrial In-Plant Health Services per FTE Employer Contribution to Private Health Insurance Premiums per FTE Employer Contribution to Medicare Hospital Insurance Trust Fund per FTE Adjusted Business Health Care Expenditures per Employee (Adjusted to 2008 US Dollars) Workers' Compensation and Temporary Disability Insurance and Industrial In-Plant Health Services per FTE Employer Contribution to Private Health Insurance Premiums per FTE Employer Contribution to Medicare Hospital Insurance Trust Fund per FTE 1990 $224 $1,502 $343 $370 $2,476 $ $247 $1,630 $389 $391 $2,578 $ $273 $1,755 $408 $419 $2,696 $ $287 $1,838 $416 $428 $2,741 $ $276 $1,864 $456 $400 $2,708 $ $266 $1,916 $470 $376 $2,708 $ $263 $2,010 $488 $361 $2,759 $ $259 $1,981 $512 $347 $2,658 $ $250 $2,084 $541 $331 $2,752 $ $261 $2,249 $565 $337 $2,905 $ $278 $2,407 $597 $347 $3,007 $ $312 $2,606 $607 $379 $3,167 $ $330 $2,855 $613 $395 $3,416 $ $353 $3,130 $632 $413 $3,660 $ $358 $3,277 $664 $408 $3,732 $ $352 $3,436 $687 $388 $3,783 $ $348 $3,429 $717 $371 $3,659 $ $354 $3,518 $746 $368 $3,652 $ $360 $3,590 $765 $360 $3,590 $765 Sources: Centers for Medicare and Medicaid Services (2008). National health expenditure data. Retrieved from Bureau of Economic Analysis (2009). National income and product accounts tables. Table 6.5C: Full-time equivalent employees by industry. Retrieved October 2010 from Bureau of Labor Statistics (2011). The Consumer Price Index: All urban consumers (CPI-U), US city average. Retrieved from ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt

5 Chart 5: Trends in Wages and Salaries and the Ratio of Health Benefits to Wages, Year Wages and Salaries Health Benefits as a (Adjusted to 2008 US Proportion of Wages and Dollars) Salaries 1990 $52, % 1991 $52, % 1992 $53, % 1993 $53, % 1994 $53, % 1995 $52, % 1996 $52, % 1997 $53, % 1998 $55, % 1999 $56, % 2000 $57, % 2001 $57, % 2002 $58, % 2003 $59, % 2004 $59, % 2005 $59, % 2006 $60, % 2007 $61, % 2008 $60, % Sources: Bureau of Economic Analysis (2009, Aug 20). National income and product accounts tables. Table 1.12: National income by type of income. Retrieved October 28, 2010, from Centers for Medicare and Medicaid Services (2012). National health expenditure data; three categories of health spending data from Chart 1, aggregated per FTE. Retrieved from Statistics-Data-and-Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/ Bureau of Labor Statistics (2011). The Consumer Price Index: All urban consumers (CPI-U), US city average. Retrieved from ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt

6 Chart 6: Trends in Manufacturing Hourly Total Compensation Costs, by Country, Adjusted 2008 US Dollars Year USA Germany Canada Japan Mexico China East Asia, Without Japan or China 1995 $24.4 $37.0 $23.7 $33.0 $ $ $24.7 $24.5 $21.0 $27.1 $ $ $26.0 $31.6 $26.8 $23.5 $2.9 $0.7 $ $25.6 $31.7 $27.9 $21.4 $3.0 $0.8 $ $26.1 $34.1 $30.2 $20.5 $3.1 $1.1 $ $25.7 $36.1 $29.8 $23.2 $3.1 $1.4 $9.5 Note: Values interpolated for missing years. Sources: Bureau of Labor Statistics (2010, Aug). Economic news release. Table 8: Production workers: Hourly compensation in US dollars in manufacturing, 33 countries or areas and selected economic groups, selected years, Retrieved from Bureau of Labor Statistics (2013). The Consumer Price Index: All urban customers (CPI-U), US city average. Retrieved from ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt Congressional Budget Office (2007). The long-term outlook for health care spending. Retrieved from

7 Chart 7: Employer Health Insurance Cost per Labor Hour, by Major Industry, 2010 Major Industry US Dollars Transportation $3.84 Manufacturing $3.37 Construction $3.09 Financial services and real estate $3.05 Whoesale trade $2.64 Services $2.13 Retail trade $1.26 Bureau of Labor Statistics (2010). Economic news release, Table 10. Private industry, by industry group [2010 data]. Retrieved from

8 Chart 8: Percentage of Firms That Offer Health Insurance, by Firm Size, 2009 Number of Employees All Firms Firms with 50% or More Low-Wage Employees Fewer than 10 34% 18% % 33% % 60% % 89% 1,000 or more 99% 99% Fewer than 50 41% 22% 50 or more 96% 93% Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends (2009) Medical Expenditure Panel Survey insurance component. Retrieved November 2010 from

9 Chart 9: Trend in the Percentage of Employees Enrolled in Private Sector Firms That Offer Health Insurance, by Firm Size, Number of Employees Year Fewer Than ,000 or More % 65.3% 65.2% 70.3% 71.2% % 65.3% 62.7% 63.9% 69.5% % 60.0% 58.2% 62.3% 71.4% % 62.4% 61.6% 63.1% 66.2% % 62.2% 58.0% 62.0% 66.6% % 59.0% 58.2% 59.4% 64.4% % 61.1% 57.7% 59.5% 64.6% % 60.1% 57.7% 61.1% 65.1% % 59.3% 58.6% 59.0% 64.7% % 57.8% 57.4% 60.0% 65.0% % 58.4% 55.9% 59.5% 62.1% % 58.2% 56.3% 59.1% 63.7% % 58.8% 58.9% 59.2% 62.5% Note: Values interpolated for Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends (2009) Medical Expenditure Panel Survey insurance component. Retrieved November 2010 from

10 Chart 10: Trends in Employee Premium Cost Sharing, by Firm Size, Year Fewer Than 50 Employees, Single Plan Percent of Total Premiums Paid by Employee 50 or More Employees, Single Plan Fewer Than 50 Employees, Family Plan 50 or More Employees, Family Plan % 18.1% 27.7% 25.3% % 16.4% 27.5% 23.8% % 19.1% 28.5% 24.0% % 19.2% 27.3% 22.9% % 17.8% 27.6% 23.0% % 18.0% 26.4% 22.6% % 18.9% 25.3% 23.1% % 18.2% 26.8% 24.3% % 19.3% 24.8% 24.3% % 18.9% 27.6% 23.5% % 19.9% 28.0% 24.9% % 20.8% 29.6% 27.3% % 21.2% 30.1% 26.1% Note: Values interpolated for Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends (2009) Medical Expenditure Panel Survey insurance component. Retrieved November 2010 from

11 Chart 11: Trends in Average Monthly Employeee Contributions to Health Insurance, by Coverage Type and Employeement Status, Year Single Coverage, Part-Time Employees Single Coverage, Full-Time Employees Dollars per Month Family Coverage, Part-Time Employees Family Coverage, Full-Time Employees 1999 $70 $58 $233 $ $61 $ $65 $ $84 $72 $304 $ $82 $71 $321 $ $87 $75 $340 $294 Notes: Premium contributions are in 2006 real dollars. Nominal premiums were deflated by the 2006 CPI-U. Values interpolated for missing years. Bureau of Labor Statistics. Employee Benefits Survey, Retrieved from

12 Chart 12: Trends in Employer Insurance Plan Deductibles, by Firm Size, Year Fewer Than 50 Employees, Single Plan Cost of Deductables 50 or More Employees, Single Plan Fewer Than 50 Employees, Family Plan 50 or More Employees, Family Plan 2002 $720 $468 $1,640 $1, $822 $529 $1,842 $1, $967 $551 $2,017 $1, $1,023 $623 $2,091 $1, $1,075 $672 $2,052 $1, $1,222 $812 $2,480 $1, $1,283 $822 $2,652 $1,610 Note: Deductibles in adjusted 2009 dollars. Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends (2009) Medical Expenditure Panel Survey insurance component. Retrieved November 2010 from

13 Chart 13: Trend in the Percentage of Private Sector Firms That Offer Health Insurance to Retirees Under Age 65, by Firm Size, Year Percent Offering Health Insurance to Retirees Firms with Fewer Than Firms with 50 or More 50 Employees Employees % 39.7% % 33.5% % 30.9% % 26.8% % 27.0% % 28.9% % 28.5% % 30.6% % 27.5% % 27.9% % 24.3% % 23.4% Sources: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends (2009) Medical Expenditure Panel Survey insurance component. Retrieved November 2010 from Kaiser Family Foundation (2011, April 15). Summary of the new health reform law. Retrieved from Kaiser Family Foundation (2011). Raising the age of Medicare eligibility: A fresh look following implementation of health reform. Retrieved from Health Affairs (2010, November 23). Early retiree insurance. Health policy brief. Retrieved from

14 Chart 14: Potential Uses of Excess Business Health Care Spending, $92 Billion in 2008 Increase in Potential Uses Spending Investment in research and development 34% Pre-tax profits 7% Investment in equipment, buildings, and software 3% Employee raises 48% Sources: Centers for Medicare & Medicaid Services (2012). National health expenditures by type of service and source of funds: Calendar years 1960 to Available from Data-and-Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.h tml Bureau of Economic Analysis (2009, Aug 20). National income and product accounts tables. Section 6 - Income and employment by industry. Annual Table 6.5C. Full-time equivalent employees by industry. Retrieved October 28, 2010, from

15 Chart 15: Trends in Household Health Care Spending, by Major Category, Year Employee and Individual Premiums US Dollars (in Billions) Total Medicare Taxes and Part A and B Premiums Out-of-Pocket Health Care Spending 1987 $44.0 $35.7 $ $52.9 $40.3 $ $60.8 $45.0 $ $68.5 $45.8 $ $77.0 $50.2 $ $81.9 $53.1 $ $88.9 $56.7 $ $92.8 $65.2 $ $100.3 $72.4 $ $103.2 $74.5 $ $112.4 $78.5 $ $119.7 $84.7 $ $124.2 $91.4 $ $133.6 $99.0 $ $147.0 $101.1 $ $167.8 $104.2 $ $183.7 $108.1 $ $196.2 $116.3 $ $207.6 $125.8 $ $220.9 $140.4 $ $231.8 $149.8 $ $252.5 $156.7 $ $256.2 $154.9 $ $263.1 $162.8 $299.7 Note: Spending unadjusted for inflation. Centers for Medicare & Medicaid Services (CMS), Office of the Actuary, National Health Statistics Group (2012). National health expenditures 2010: Sponsor highlights. Retrieved from

16 Chart 16: Trends in Per Capita Out-of-Pocket Health Care Spending, in Total and as a Share of Total Spending, Year Per Capita Out-of-Pocket Personal Health Care Spending Per Capita Total Personal Health Care Spending Out-of-Pocket Share of Total Personal Health Care Spending 1965 $635 $1, % 1966 $630 $1, % 1967 $603 $1, % 1968 $639 $1, % 1969 $664 $1, % 1970 $684 $1, % 1971 $675 $1, % 1972 $706 $1, % 1973 $745 $2, % 1974 $735 $2, % 1975 $707 $2, % 1976 $716 $2, % 1977 $745 $2, % 1978 $740 $2, % 1979 $731 $2, % 1980 $709 $2, % 1981 $703 $2, % 1982 $714 $2, % 1983 $741 $2, % 1984 $774 $3, % 1985 $817 $3, % 1986 $844 $3, % 1987 $875 $3, % 1988 $914 $3, % 1989 $911 $3, % 1990 $932 $4, % 1991 $891 $4, % 1992 $873 $4, % 1993 $842 $4, % 1994 $802 $4, % 1995 $787 $4, % 1996 $790 $4, % 1997 $816 $4, % 1998 $870 $4, % 1999 $899 $5, % 2000 $920 $5, % 2001 $909 $5, % 2002 $945 $5, % 2003 $973 $6, % 2004 $992 $6, % 2005 $1,014 $6, % 2006 $997 $6, % 2007 $1,021 $6, % 2008 $991 $6, % 2009 $988 $7, % 2010 $970 $7, % Note: Spending deflated by CPI in 2009 dollars. Centers for Medicare & Medicaid Services (2012). National health expenditures by type of service and source of funds: Calendar years 1960 to Available from Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

17 Chart 17: Trends in Out-of-Pocket Spending as a Share of Total Health Care Spending, by Major Service, Year Total Health Expenditures Percent of Total Health Care Spending Dental Nursing Home Care Prescription Drugs Physician and Clinical Services Hospital Care % 91.0% 52.0% 82.4% 46.2% 9.0% % 90.5% 49.4% 80.9% 44.3% 8.1% % 89.9% 49.0% 78.3% 42.6% 8.8% % 89.0% 49.4% 79.6% 40.8% 9.5% % 86.8% 42.6% 77.0% 38.9% 9.1% % 82.2% 40.0% 75.4% 36.4% 8.4% % 77.7% 40.4% 74.2% 35.8% 7.6% % 75.5% 39.8% 73.4% 35.0% 7.2% % 72.3% 38.2% 71.9% 32.8% 6.6% % 69.3% 36.1% 69.5% 31.7% 6.0% % 66.4% 35.7% 70.3% 30.4% 5.4% % 64.3% 35.2% 66.0% 29.6% 5.3% % 62.3% 37.0% 68.3% 28.8% 5.4% % 60.3% 37.5% 65.0% 27.7% 5.3% % 58.4% 37.0% 63.7% 27.3% 5.3% % 56.6% 37.4% 62.4% 27.2% 5.4% % 54.8% 37.2% 63.6% 27.3% 4.8% % 51.9% 35.6% 61.0% 25.2% 4.8% % 50.7% 36.7% 59.8% 23.3% 4.8% % 49.4% 34.6% 58.0% 21.1% 4.6% % 48.5% 36.1% 55.5% 19.2% 4.5% % 47.4% 33.5% 51.9% 17.5% 4.4% % 46.4% 31.7% 49.2% 15.9% 4.2% % 45.0% 29.9% 47.3% 14.5% 3.9% % 44.3% 27.8% 43.1% 13.1% 3.3% % 43.6% 28.1% 38.4% 11.8% 3.0% % 43.0% 26.7% 35.3% 11.7% 2.9% % 44.2% 27.1% 33.0% 11.8% 3.0% % 44.5% 30.1% 31.1% 11.6% 3.2% % 44.1% 30.4% 29.1% 11.4% 3.3% % 44.6% 30.1% 27.7% 11.1% 3.3% % 43.3% 28.5% 26.0% 10.7% 3.2% % 44.1% 28.1% 25.6% 10.4% 3.2% % 44.5% 27.6% 25.3% 10.3% 3.3% % 44.2% 26.9% 24.5% 10.2% 3.3% % 44.3% 26.2% 24.4% 10.4% 3.3% % 44.3% 26.0% 21.6% 10.4% 3.2% % 44.3% 26.8% 21.6% 10.4% 3.2% % 44.1% 26.7% 20.7% 10.1% 3.2% Centers for Medicare and Medicaid Services (2012), NHE by type of service and source of funds, CY , NHE60_10_Final.csv. Retrieved from Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

18 Chart 18: Out-of-Pocket Health Care Spending as a Percentage of Income, by Age Group, 2009 Age Group Percent of Income All ages 5.15% Under 25 years 2.65% years 3.15% years 3.36% years 4.10% years 5.76% 65 and older 12.41% Note: Income after taxes. Bureau of Labor Statistics (2010). Consumer Expenditure Survey, Health care spending by age (Series CXUHC000401) and Gross income before taxes (Series CXUAI000201)

19 The Nation's Health Care Bill: Who Bears the Burden? Chart 19 Chart 19: Percentage of Adults Aged with Medical Bills or Accrued Medical Debt Problems, by Income Level, 2007 Income Level (see Note) Percentage of Adults All 41% Low income 53% Moderate income 56% Middle income 39% High income 25% Note: Low income is defined as less than $20,000; moderate income, $30,000 $39,999; middle income, $40,000 $59,999; and high income, $60,000 or more per year. Collins, S. R., Kriss, J. L., Doty, M. M., & Rustgi, S. D. (2008, Aug). Losing ground: How the loss of adequate health insurance is burdening working families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys, New York: The Commonwealth Fund.

20 Chart 20: Medical Debt at Bankruptcy Filing, by Health Insurance Status, 2007 Health Insurance Status Medical Debt (US Dollars) Veterans Administration (VA) or military $6,545 Medicare $12,021 Medicaid $14,633 Private insurance at onset $17,749 Lost private insurance $22,568 Uninsured $26,971 US average $17,943 Notes: Information is based on bankruptcy filings and interviews with families filing for bankruptcy. Private insurance at onset indicates that the individual had and retained coverage after the onset of illness. Himmelstein, D. U., Thorne, D., Warren, E. & Woolhandler, S. (2009). Medical bankruptcy in the United States, 2007: Results of a national study. The American Journal of Medicine. 122,

21 Chart 21: Trends in the Number of Uninsured, by Race and Ethnicity, Number Uninsured (in Thousands) Year All Races Whites Alone Blacks Alone Hispanic, Any Race ,026 23,900 5,862 5, ,680 25,211 5,875 6, ,384 25,857 5,842 6, ,719 26,959 6,093 6, ,444 27,127 6,507 6, ,641 29,719 6,568 8, ,713 30,489 6,761 8, ,718 30,304 6,603 9, ,581 31,105 7,108 9, ,715 31,729 7,419 9, ,448 33,241 7,432 10, ,281 33,588 7,796 11, ,554 31,863 7,536 10, ,702 29,865 7,118 11, ,586 30,075 6,682 11, ,023 31,193 6,833 11, ,776 29,624 6,743 12, ,949 31,607 6,742 12, ,752 31,751 6,592 12, ,035 32,669 6,678 13, ,214 34,169 7,375 14, ,088 33,224 7,021 14, ,780 33,767 7,018 14, ,985 37,124 7,838 15, ,904 37,385 8,132 15,341 Notes: 1993: individuals 18 and older; 1998: individuals 20 and older; all other years: individuals 21 and older. Totals for blacks, Hispanics, and whites do not add to total uninsured for All Races due to minor double-counting among Hispanics and unreported races. US Census Bureau (2011). Current Population Survey, Annual Social and Economic Supplements. Table H-1. Health insurance coverage status and type of coverage by sex, race, and Hispanic origin: 1987 to Retrieved from

22 Chart 22: Trends in the Percentage of the US Population Insured by Private Employers, Medicare, and Medicaid, Year Percent Employer Insured Percent Medicare Insured Percent Medicaid Insured % 13.0% 9.7% % 13.1% 10.7% % 12.9% 11.5% % 12.7% 12.2% % 12.9% 12.1% % 13.1% 12.1% % 13.2% 11.8% % 13.2% 10.8% % 13.2% 10.3% % 13.3% 10.3% % 13.5% 10.6% % 13.5% 11.2% % 13.4% 11.6% % 13.7% 12.4% % 13.6% 13.0% % 13.7% 13.0% % 13.6% 12.9% % 13.8% 13.2% % 14.3% 14.1% % 14.3% 15.7% Note: Sources: Excludes small percentage with direct purchase of health insurance. US Census Bureau (selected years). Current Population Survey, Annual Social and Economic Supplements, Table HIA-2. Health insurance coverage status and type of coverage all persons by age and sex: 1999 to 2009, retrieved from and Table HI-7. Health insurance coverage status and type of coverage by age: 1987 to 2005, retrieved from BLS employment statistics.

23 Chart 23: Reasons for Passing Up a Job Opportunity or Postponing Retirement Based on Health Benefits, 2004 Reason Percent Could not afford health insurance on your own 39% The potential employer did not offer health insurance 15% You or a family member had a medical condition that would not be covered by a potential employer's health plan 14% The potential employer offered fewer benefits 11% The potential employer's health plan cost too much 8% Did not look because I want to keep current insurance 5% Other reason, don't know, or no answer 9% Helman, R., Mathew Greenwald & Associates, & Fronstin, P. (2004). Public attitudes on the US health care system: Findings from the Health Confidence Survey. Employee Benefit Research Institute (EBRI) Issue Brief No Washington, DC: EBRI. Retrieved from

24 Chart 24: Potential Uses of Excess Household Health Care Spending in 2008: $80 Billion ($698 per Household) Additional savings at time of retirement using 5% annual rate of Years to Retirement return, US dollars 10 years $9, years $24, years $48,720 Bankrate.com

25 Chart 25: Federal Spending on Health and Other Services, 1965 and 2005 Note: Federal Spending (US Dollars, in Millions) Sector National defense $50,620 $495,308 Social Security $17,460 $523,305 Public debt $11,346 $352,345 Income Security $6,604 $252,496 General science, space, and technology $5,823 $23,597 Transportation $5,763 $67,894 Health $1,791 $549,186 Education $1,132 $69,713 Spending in 2005 unadjusted for inflation. Health and education spending adjusted for intergovernmental transfers. Historical tables: Budget of the US government (multiple years). Retrieved from

26 Chart 26: Trends in Shares of State and Local Spending on Health and Other Services, Total Health Public Safety Percent of Total Spending by State and Local Governments Cash Assistance and Subsidies Education K-12 Education Higher Ed Transportation Public Housing Environmental % 5.9% 3.5% 21.4% 7.8% 9.4% 1.4% 2.8% % 5.9% 3.5% 20.6% 7.8% 9.1% 1.5% 2.7% % 6.1% 3.3% 20.2% 7.9% 8.7% 1.6% 2.7% % 6.2% 3.3% 19.9% 7.7% 8.6% 1.5% 2.7% % 6.4% 3.3% 20.1% 7.9% 8.8% 1.5% 2.6% % 6.5% 3.1% 20.1% 8.0% 8.9% 1.6% 2.7% % 6.6% 3.1% 20.2% 7.9% 8.9% 1.6% 2.7% % 6.7% 3.0% 20.2% 7.7% 8.8% 1.5% 2.7% % 6.9% 2.9% 20.5% 7.6% 8.7% 1.6% 2.7% % 6.8% 2.8% 20.8% 7.6% 8.4% 1.7% 2.7% % 7.0% 2.8% 20.7% 7.5% 8.2% 1.6% 2.7% % 7.0% 2.9% 20.5% 7.4% 8.0% 1.6% 2.7% % 6.8% 2.9% 19.6% 7.3% 7.7% 1.5% 2.5% % 6.7% 2.9% 19.8% 7.3% 7.4% 1.5% 2.4% % 6.9% 2.8% 19.5% 7.2% 7.6% 1.6% 2.4% % 6.9% 2.7% 19.6% 7.2% 7.6% 1.6% 2.5% % 7.1% 2.6% 20.0% 7.2% 7.5% 1.6% 2.5% % 7.3% 2.3% 20.1% 7.3% 7.4% 1.6% 2.6% % 7.4% 2.1% 20.8% 7.4% 7.5% 1.6% 2.6% % 7.4% 1.9% 20.9% 7.5% 7.5% 1.6% 2.6% % 7.4% 1.8% 20.9% 7.7% 7.6% 1.5% 2.6% % 7.2% 1.7% 20.7% 7.7% 7.4% 1.4% 2.6% % 7.1% 1.6% 20.0% 7.6% 7.4% 1.5% 2.5% % 7.0% 1.6% 19.8% 7.6% 7.4% 1.6% 2.5% % 6.9% 1.7% 19.9% 7.6% 7.1% 1.6% 2.4% % 7.0% 1.7% 19.9% 7.7% 7.1% 1.7% 2.4% % 7.0% 1.6% 20.0% 7.6% 7.2% 1.7% 2.4% % 7.1% 1.5% 20.1% 7.7% 7.2% 1.7% 2.5% % 7.1% 1.5% 19.9% 7.9% 7.2% 1.8% 2.5% US Census Bureau (2012). State and local governments revenue and expenditures by function. Retrieved from

27 Chart 27: Health Care and Other Major Federal Tax Expenditures, 1990 and 2010 Tax Expenditures (US Dollars, in Billions) Deductions for mortgage interest $25.4 $90.5 Deductions for employer health premiums $32.6 $135.6 Exclusion of Medicare benefits $9.0 $50.0 Exclusion of Social Security $21.0 $25.0 Exclusion of employer/individual retirement plans $59.8 $158.2 Deductions for state/local taxes $19.0 $30.0 Note: Expenditures unadjusted for inflation. Joint Committee on Taxation (House Committee on Ways and Means and Senate Committee on Finance). (Selected years). Estimates of federal tax expenditures. Washington, DC: US Government Printing Office.

28 Chart 28: The Medicare Subsity for Retirees, 1960, 2010, and 2030 Medical Subsidy Household Status (Annual Wage in (Adjusted 2011 US Dollars) Parentheses) Single woman ($43,500) $23,000 $38,000 $38,000 One-earner couple ($43,500) $127,000 $293,000 $202,000 Two-earner couple ($69,600 and $43,500) $188,000 $440,000 $300,000 Sources: Steuerle, C. E., & Rennane, S. (2011). Social Security and Medicare taxes and benefits over a lifetime. Washington, DC: Urban Institute. Retrieved from Old-Age and Survivors Insurance and Federal Disability Insurance (OASDI) Board of Trustees. (2011). The 2011 annual report of the board of trustees of the federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds (2011 OASDI Trustees Report). Retrieved from

29 Chart 29: State Wealth and Taxpayer Medicaid Spending Burden, 2005 State Taxpayer Health Burden Low/High Taxpayer Burden Per Capita Wealth Low/High State Per Capita Wealth Alabama 8.21% L $31,016 L Alaska 9.41% L $54,226 H Arizona 10.08% L $32,705 L Arkansas 9.09% L $29,762 L California 11.12% H $42,046 H Colorado 7.05% L $43,169 H Connecticut 11.10% H $51,981 H Delaware 9.00% L $61,999 H Florida 8.49% L $34,254 L Georgia 7.55% L $37,446 L Hawaii 9.05% L $39,396 H Idaho 7.13% L $30,445 L Illinois 9.33% L $41,818 H Indiana 9.17% L $36,583 L Iowa 8.37% L $37,154 L Kansas 8.20% L $36,043 L Kentucky 10.02% L $31,869 L Louisiana 8.67% L $35,411 L Maine 16.44% H $32,734 L Maryland 10.87% H $41,193 H Massachusetts 15.39% H $48,869 H Michigan 9.75% L $36,222 L Minnesota 11.87% H $43,762 H Mississippi 10.00% L $26,397 L Missouri 11.88% H $35,489 L Montana 7.36% L $29,479 L Nebraska 8.94% L $38,657 H Nevada 5.32% L $41,056 H New Hampshire 10.39% H $39,761 H New Jersey 11.11% H $47,065 H New Mexico 10.77% H $33,004 L New York 23.97% H $47,094 H North Carolina 9.81% L $37,309 L North Dakota 7.41% L $35,641 L Ohio 11.23% H $37,088 L Oklahoma 8.19% L $31,522 L Oregon 8.11% L $36,971 L Pennsylvania 14.86% H $37,310 L Rhode Island 18.47% H $38,882 H South Carolina 9.20% L $30,902 L South Dakota 6.61% L $38,275 H Tennessee 9.94% L $36,353 L Texas 7.67% L $39,510 H Utah 5.09% L $33,425 L Vermont 17.86% H $35,297 L Virginia 7.07% L $43,216 H Washington 10.75% H $40,250 H West Virginia 11.20% H $27,467 L Wisconsin 9.33% L $37,524 L Wyoming 7.71% L $47,305 H National Average 10.11% --- $38, Notes: Sources: State wealth = gross state product (GSP). Taxpayer health burden = state-only Medicaid spending as a perce Bureau of Economic Analysis (2009). Gross domestic product by state. Advance statistics for 2008 and revised statistics for Retrieved from Centers for Medicare & Medicaid Services (2006). CMS-64 quarterly expense report. Retrieved from Quarterly-Expense-Report.html Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group (2012). National health expenditures 2010: Sponsor highlights. Retrieved from US Census Bureau (2007). The statistical abstract of the United States, 2007; Table 17. Resident population States: 1980 to US Census Bureau (2011). Number and percentage of people without health insurance coverage by state using 2- and 3-year averages: and Retrieved from

30 THe Nation's Health Care Bill: Who Bears the Burden? A Chartbook Chart 30: Potential Uses of Excess Federal Health Spending, 2008: $273.7 Billion US Dollars (in Billions) Actual Spending (Debt) in 2008 Total with Excess $273.7 Billion Federal Health Spending Potential Uses Education for kindergarten to 12th grade and higher (college) $73.1 $346.8 Natural resources, the environment, and ground transportation $81.9 $355.6 Public assistance, housing, and food and nutrition $262.5 $536.2 Reduce the federal debt interest ($451.1) ($177.4) Reduce the annual deficit ($458.6) ($184.9) Reduce taxes of taxpayers making less than $100,000 ($269.6) $0.0 Sources: Historical tables: Budget of the US government (multiple years). Retrieved from Centers for Medicare & Medicaid Services (2012). NHE summary including share of GDP, CY Retrieved from Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html US Census Bureau (2006). Statistical abstract of the United States: Washington, DC. Retrieved from

31 Chart 31: Potential Uses of Excess State Health Care Spending, 2008: $140.9 Billion Potential Uses US Dollars (in Billions) Actual Spending (Savings) in 2008 Total with Excess $140.9 Billion State Health Spending Highway funding $135.4 $275.9 Police protection $79.1 $220.0 Classroom teachers $160.3 $343.0 Reduce public college tuition and room/board ($171.6) ($15.5) Cover all debt interest and reduce corporate taxes by 80% ($150.4) ($9.5) Note: Sources: Percentages based on undeflated dollars. US Census Bureau (2008). State and local government finance. Historial data: Retrieved from Centers for Medicare & Medicaid Services (2012). NHE summary including share of GDP, CY Retrieved from

32 Chart 32: Cumulated Invested Excess Health Care Spending: Businesses, Househohlds, the Federal Government, and State/Local Governments, Cumulated Invested Excess Health Care Spending Relative to 1990 ($Billions) Year Private Business Households Federal Government State Government 1991 $34.21 $32.66 $73.67 $ $50.17 $10.31 $ $ $55.88 $0.48 $ $ $ $25.00 $ $ $ $13.43 $ $ $ $33.63 $ $ $ $22.37 $ $ $44.44 $0.86 $ $ $ $4.03 $93.58 $ $80.41 $0.52 $91.61 $ $ $15.69 $ $ $ $50.54 $ $ $ $65.74 $ $ $ $62.70 $ $ $ $59.76 $ $ $ $59.25 $ $ $ $62.17 $ $ $92.12 $79.78 $ $ Cumulative, $1, $ $3, $1, Notes: Cumulative value of excess spending over period based on actual health care spending and constrained to the growth in GDP. Each year s excess is expressed in 2008 dollars and then compounded by the 8.6 percent annual growth in the Dow Jones Stock Market Index. Sources: Centers for Medicare & Medicaid Services (2012). NHE summary including share of GDP, CY Retrieved from Data-and-Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html StockCharts.com (2012, Sept 1). Dow Jones Industrial Average ( daily)- charting tools. Retrieved from

33 Chart 33: Trends in US Life Expectancy at Birth, Whites and Blacks, Life Expectancy (in Years) Year of Birth All Races Whites Blacks Xu, J.Q., Kochanek, K.D., Murphy, S.L., Tejada-Vera, B. (2010). Deaths: Final data for 2007, Table 8. National vital statistics reports, 58(19). Hyattsville, MD: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Retrieved from

34 Chart 34: Trends in Infant Mortality per 1,000 Births, Whites and Blacks, Infant Mortality Rate (Per 1,000 Live Births) Year All Races Whites Blacks Note: Infants under age 1. Sources: Xu, J.Q., Kochanek, K.D., Murphy, S.L., Tejada-Vera, B. (2010). Deaths: Final data for National Vital Statistics Reports, 58(19). Hyattsville, MD: National Center for Health Statistics. Retrieved from Centers for Disease Control and Prevention (2009). Health, United States Retrieved from Unpublished data.

35 Chart 35: Variation in Infant Mortality Rates, by State and Insurance Coverage, 2007 Infant Mortality Rate (per 1,000 Live Births) Percent of Population Uninsured Above or Below State Average Percent Uninsured* State Alabama % 2 Alaska % 1 Arizona % 1 Arkansas % 1 California % 1 Colorado % 1 Connecticut % 2 Delaware % 2 District of Columbia % 2 Florida % 1 Georgia % 1 Hawaii % 2 Idaho % 1 Illinois % 2 Indiana % 2 Iowa % 2 Kansas % 2 Kentucky % 1 Louisiana % 1 Maine % 2 Maryland % 2 Massachusetts % 2 Michigan % 2 Minnesota % 2 Mississippi % 1 Missouri % 2 Montana % 1 Nebraska % 2 Nevada % 1 New Hampshire % 2 New Jersey % 1 New Mexico % 1 New York % 2 North Carolina % 1 North Dakota % 2 Ohio % 2 Oklahoma % 1 Oregon % 1 Pennsylvania % 2 Rhode Island % 2 South Carolina % 1 South Dakota % 2 Tennessee % 1 Texas % 1 Utah % 2 Vermont % 2 Virginia % 2 Washington % 2 West Virginia % 1 Wisconsin % 2 Wyoming % 1 United States % State average 14.5% *1 = below average percent insured; 2 = above average percent insured. Sources: Matthews, T. J., & MacDorman, M. F. (2011, June 29). Infant mortality statistics from the 2007 period linked birth/infant death data set. Division of Vital Statistics. National Vital Statistics Report, 59(6). Hyattsville, MD: National Center for Health Statistics. Retrieved from Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau s March 2009 and 2010 Current Population Survey (CPS: Annual Social and Economic Supplements).

36 Chart 36: Trends in Age-Adjusted Death Rates per 100,000 from Heart Disease and Cancer, Deaths per 100,000 Year Cancer Heart Disease Xu, J.Q., Kochanek, K.D., Murphy, S.L., Tejada-Vera, B. (2010). Deaths: Final data for 2007, Table 29. Number of deaths, death rates, and age-adjusted death rates for major causes of death: United States, each state, Puerto Rico, Virgin Islands, Guam, American Samoa, and Northern Marianas, National Vital Statistics Reports, 58(19). Hyattsville, MD: National Center for Health Statistics. Retrieved from

37 Chart 37: Variation in Death Rates Due to Heart Disease, by State and Insurance Coverage, 2007 State Deaths Due to Heart Disease (per 100,000) Percent of Population Uninsured Above or Below State Average Percent Uninsured* Alabama % 2 Alaska % 1 Arizona % 1 Arkansas % 1 California % 1 Colorado % 1 Connecticut % 2 Delaware % 2 District of Columbia % 2 Florida % 1 Georgia % 1 Hawaii % 2 Idaho % 1 Illinois % 2 Indiana % 2 Iowa % 2 Kansas % 2 Kentucky % 1 Louisiana % 1 Maine % 2 Maryland % 2 Massachusetts % 2 Michigan % 2 Minnesota % 2 Mississippi % 1 Missouri % 2 Montana % 1 Nebraska % 2 Nevada % 1 New Hampshire % 2 New Jersey % 1 New Mexico % 1 New York % 2 North Carolina % 1 North Dakota % 2 Ohio % 2 Oklahoma % 1 Oregon % 1 Pennsylvania % 2 Rhode Island % 2 South Carolina % 1 South Dakota % 2 Tennessee % 1 Texas % 1 Utah % 2 Vermont % 2 Virginia % 2 Washington % 2 West Virginia % 1 Wisconsin % 2 Wyoming % 1 United States % State average 14.5% *1 = below average percent insured; 2 = above average percent insured. Sources: Xu, J.Q., Kochanek, K.D., Murphy, S.L., Tejada-Vera, B. (2010). Deaths: Final data for 2007, Table 29. Number of deaths, death rates, and age-adjusted death rates for major causes of death: United States, each state, Puerto Rico, Virgin Islands, Guam, American Samoa, and Northern Marianas, National Vital Statistics Reports, 58(19). Hyattsville, MD: National Center for Health Statistics. Retrieved from Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau s March 2009 and 2010 Current Population Survey (CPS: Annual Social and Economic Supplements).

38 Chart 38: Variation in Sigmoidoscopy or Colonoscopy Rates in Adults Aged 50 and Older, by State and Insurance Coverage, 2010 Percent of Population Aged 50 and Older Who Have Ever Had a Sigmoidoscopy or Colonoscopy Percent of Population Uninsured Above or Below State Average Percent Uninsured* State Alabama 63.9% 14.4% 2 Alaska 61.9% 19.2% 1 Arizona 66.8% 19.6% 1 Arkansas 60.9% 18.6% 1 California 61.5% 19.3% 1 Colorado 65.3% 15.7% 1 Connecticut 75.7% 11.0% 2 Delaware 74.0% 12.2% 2 District of Columbia 70.8% 11.2% 2 Florida 68.2% 21.3% 1 Georgia 67.7% 19.3% 1 Hawaii 61.5% 8.2% 2 Idaho 59.8% 15.4% 1 Illinois 61.9% 13.9% 2 Indiana 62.8% 13.2% 2 Iowa 64.2% 10.5% 2 Kansas 64.2% 12.8% 2 Kentucky 63.7% 16.1% 1 Louisiana 60.8% 18.0% 1 Maine 74.3% 10.3% 2 Maryland 72.3% 13.1% 2 Massachusetts 75.2% 5.0% 2 Michigan 70.9% 12.7% 2 Minnesota 72.2% 8.7% 2 Mississippi 59.5% 17.8% 1 Missouri 65.2% 14.0% 2 Montana 61.0% 15.8% 1 Nebraska 61.8% 11.7% 2 Nevada 61.5% 19.9% 1 New Hampshire 75.2% 10.4% 2 New Jersey 65.6% 15.0% 1 New Mexico 61.3% 22.8% 1 New York 71.2% 14.4% 2 North Carolina 69.6% 16.8% 1 North Dakota 61.1% 11.3% 2 Ohio 64.0% 12.9% 2 Oklahoma 58.0% 16.2% 1 Oregon 66.1% 17.0% 1 Pennsylvania 68.0% 10.7% 2 Rhode Island 74.5% 12.1% 2 South Carolina 67.3% 16.4% 1 South Dakota 67.1% 13.1% 2 Tennessee 60.5% 15.3% 1 Texas 61.6% 25.7% 1 Utah 69.9% 14.1% 2 Vermont 73.1% 9.6% 2 Virginia 69.3% 12.9% 2 Washington 70.7% 12.8% 2 West Virginia 54.4% 14.6% 1 Wisconsin 69.4% 9.6% 2 Wyoming 59.3% 14.8% 1 United States 64.2% 16.7% State average 14.5% *1 = below average percent insured; 2 = above average percent insured. Sources: Centers for Disease Control and Prevention (CDC) (2010). Sigmoidoscopy and colonoscopy rates: The Behavioral Risk Factor Surveillance System, Retrieved from Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau s March 2009 and 2010 Current Population Survey (CPS: Annual Social and Economic Supplements).