CHAPTER 1. Trends in the Overall Health Care Market

Transcription

1 CHAPTER 1 Trends in the Overall Health Care Market

2 Billions Chart 1.1: Total National Health Expenditures, $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 Inflation Adjusted (2) Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see (2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.

3 Percent Change 5.6% 5.2% 4.5% 4.0% 4.1% 3.5% 2.9% 4.0% 4.3% 5.7% 5.8% 5.1% 6.4% 7.1% 7.3% 6.8% 6.5% 6.5% 5.8% 8.5% 8.5% 9.6% Chart 1.2: Percent Change in Total National Health Expenditures, % 10% 8% 6% 4% 2% 0% Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

4 Per Capita Amount Chart 1.3: Per Capita National Health Expenditures, $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 Inflation Adjusted (2) $ Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see (2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.

5 Percentage of GDP 13.9% 13.8% 13.7% 13.7% 13.8% 13.3% 14.0% 14.8% 15.4% 15.4% 15.5% 15.6% 15.9% 16.3% 17.3% 17.4% 17.3% 17.3% 17.2% 17.4% 17.7% 17.9% Chart 1.4: National Health Expenditures as a Percentage of Gross Domestic Product, % 20% 15% 10% 5% 0% Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

6 Chart 1.5: National Expenditures for Health Services and Supplies by Category, 1980 and 2016 (2) $235.5B $3,179.8B Other (3), 11.4% Other (3), 16.3% Nursing Home Care, 6.5% Other Medical Durables and Non-durables, 5.9% Prescription Drugs, 5.1% Home Health Care, 1.0% Other Professional (4), 7.1% Physician Services, 20.3% Nursing Home Care, 5.1% Other Medical Durables and Non-durables, 3.6% Prescription Drugs, 10.3% Home Health Care, 2.9% Other Professional (4), 6.8% Physician Services, 20.9% Hospital Care, 42.7% Hospital Care, 34.0% Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, Excludes medical research and medical facilities construction. (2) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see (3) Other includes net cost of insurance and administration, government public health activities, and other personal health care. (4) Other professional includes dental and other non-physician professional services.

7 Percent Change Chart 1.6: Percent Change in National Expenditures for Selected Health Services and Supplies, % 15% Hospital Care Home Health Care Prescription Drugs Nursing Home Care Admin. & Net Cost of Private Health Insurance 10% 5% 0% -5% Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

8 Billions Chart 1.7: National Health Expenditures, (2) $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $ Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, Years are projections. (2) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

9 Billions Chart 1.8: Consumer Out-of-pocket Payments for National Health Expenditures, $400 $350 $300 $250 $200 $150 $100 $50 $ Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

10 Billions Chart 1.9: Total Prescription Drug Spending, $360 $320 $280 $240 $200 $160 $120 $80 $40 $0 National Prescription Drug Spending Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

11 Billions Chart 1.10: Consumer Out-of-pocket Spending vs. Private Health Insurance Spending for Prescription Drugs, $200 $150 $100 Private Health Insurance $50 Out-of-pocket $ Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

12 Chart 1.11: Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2016 $255.3B $1,369.1B $3,337.2B 22.8% 14.5% 6.1% 10.3% 4.7% Out-of-Pocket Other Private 7.8% 27.1% 33.5% 32.8% Private Insurance 17.5% 10.2% 14.7% 14.8% 13.7% 17.8% Other Government Total Medicaid 14.6% 16.4% 20.6% Total Medicare Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see

13 Chart 1.12: Distribution of Health Insurance Coverage, Percentage of Population Covered by Payer*, 1990, 2010, and 2016 Private 64.0% 67.5% 73.2% Medicare 13.0% 14.6% 16.7% Medicaid Other Government 9.7% 4.0% 4.2% 4.6% 15.8% 19.4% Uninsured 13.9% 16.3% 8.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% Source: US Census Bureau, Current Population Survey, 2016 Annual and Social Economic Supplement. Data released September Table HI01. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: Percentages across categories do not sum to 100 percent, as individuals may maintain coverage from multiple payers (e.g. Medicare and Medicaid, Medicare and private, etc.)

14 Number of Uninsured (Millions) Percent of Total Population Chart 1.13: Number and Percent Uninsured, Number Percent 18% 16% 14% 12% 10% % 6% 4% 2% % Source: US Census Bureau, Health Insurance Coverage in the United States: Data released September Figure HIC-4. HIC-4. Health Insurance Coverage Status and Type of Coverage by State--All Persons: 2008 to Link:

15 Chart 1.14: Average Percent Uninsured by State, 2015 and 2016 RI 4.3% DE 5.7% DC 3.9% < 5.0% 5.0% - 9.9% 10.0% % 15.0% Source: US Census Bureau, Health Insurance Coverage in the United States: Data released September Figure HIC- 4. HIC-4. Health Insurance Coverage Status and Type of Coverage by State--All Persons: 2008 to Link: Chart represents a weighted average uninsured rate for the years indicated.

16 Millions Chart 1.15: Medicare Enrollees, Source: Centers for Medicare & Medicaid Services. Medicare Enrollment: National Trends, ; Medicare Aged and Disabled Enrollees by Type of Coverage. CMS, Office of the Actuary. correspondence with CMS staff (for years ). Hospital insurance (Part A) enrollees and/or Supplementary Medical Insurance (Part B) enrollees, including enrollees with Medicare Advantage; includes all persons (aged and disabled).

17 Millions Chart 1.16: Medicaid Enrollees, 1990, 1995, 2000, 2005, (2) Other Title XIX Adults Children Blind/Disabled 0 (3) Aged Source: Congressional Budget Office. Data released January Detail of Spending and Enrollment for CBO s January 2017 Baseline: Medicaid. Link: medicaid.pdf Does not include CHIP enrollees. (2) In 1997, the Other Title XIX category was dropped and the enrollees therein were subsumed in the remaining categories. Other Title XIX enrollees referred to others who received Medicaid benefits. (3) For 2014 onward, CBO changed from reporting annual enrollment to average monthly enrollment. Therefore, category values are derived from the total ever enrolled for each year.

18 Millions Chart 1.17: National CHIP Enrollment, (1,2) FY 1999 FY ' Source: Centers for Medicare & Medicaid Services. Data released July Number of Children Ever Enrolled Report. Link: Number of children enrolled at any point in the year. (2) 2009 figure reflects revised data released by Centers for Medicare & Medicaid Services on February 1, 2011.

19 Chart 1.18: Percent Change in CHIP Enrollment by State, FY 2015 FY 2016 RI 15.8% DE 8.8% DC 30.6% < - 20% - 10% % 0% - - 9% 1% - 9% 10% - 19% 20% - 29% 30% Source: Centers for Medicare & Medicaid Services. Data released July Number of Children Ever Enrolled Report. Link:

20 Chart 1.19: Percentage of Employees with Employer-based Coverage Who Can Choose Conventional, PPO, HMO, POS and, HDHP/SO Plans, % (2) (3) Conventional PPO HMO POS HDHP/SO 80% 60% 40% 20% 0% Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released Employer Health Benefits: 1999, 2002, Link: KPMG Survey of Employer-Sponsored Health Benefits: 1988, PPO: Preferred Provider Organization; HMO: Health Maintenance Organization. Conventional plans refer to traditional indemnity plans. (2) Point-of-service (POS) plans not separately identified in (3) In 2006, the survey began asking about HDHP/SO, high deductible health plans with a savings option.

21 Chart 1.20: Distribution of Employer-sponsored Health Insurance Enrollment by Type of Plan, % 80% 60% 40% HDHP/SO POS HMO PPO (2) (3) 20% 0% Conventional Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released Employer Health Benefits: 1999, 2002, Link: KPMG Survey of Employer-Sponsored Health Benefits: 1988, PPO: Preferred Provider Organization; HMO: Health Maintenance Organization. Conventional plans refer to traditional indemnity plans. (2) Point-of-service (POS) plans not separately identified in (3) In 2006, the survey began asking about HDHP/SO, high deductible health plans with a savings option.

22 Percentage of Beneficiaries 8% 10% 13% 13% 12% 12% 13% 16% 17% 17% 15% 17% 20% 22% 24% 25% 25% 27% 28% 30% 32% 32% Chart 1.21: Percentage of Medicare Beneficiaries Enrolled in Medicare Managed Care, % 33% 30% 27% 24% 21% 18% 15% 12% 9% 6% 3% 0% Source: Centers for Medicare & Medicaid Services, Office of the Actuary. correspondence with CMS staff in June 2017.

23 Chart 1.22: Percent Growth in Medicare Spending per Beneficiary vs. Private Health Insurance Spending per Enrollee, (1,2) 12% 10% 8% Private Health Insurance 6% 4% 2% 0% -2% Medicare (3) Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released December 6, CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see (2) Data reflects spending on benefits commonly covered by Medicare and Private Health Insurance. (3) CMS no longer includes the National Health Expenditure (NHE) table used to calculate growth in Medicare spending from Data for 2014 and subsequent years reflects calculations using current NHE tables as recommended by CMS in correspondence.

24 Chart 1.23: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care, , % 75% 50% 80% 81% 71% 72% 71% 74% 77% 72% 63% 65% 64% 54% 56% 56% 57% 58% 59% 61% 48% 40% 25% 29% 0% CMS has not released data for 2012 total Medicaid managed care enrollment. Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment and Program Characteristics, 2016, released Spring Link:

25 Chart 1.24: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care by State, 2016 RI 73.1% DE 88.6% DC 71.9% < 1% 1% - 60% 60% - 74% 75% - 89% 90% - 99% 100% Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment and Program Characteristics, 2016; released Spring medicaid-managed-care-enrollment-report.pdf. and the Kaiser Family Foundation. State Health Facts. Total Medicaid Managed Care Enrollment. Link:

26 Chart 1.25: Status of State Medicaid Expansion Decisions, 2018 WA ME OR CA NV ID AZ UT MT WY CO NM ND SD NE KS OK MN WI IA MO AR IL MS NY MI PA OH IN WV VA KY NC TN SC AL GA VTNH NJ MA CT DE MD D.C. RI Not adopting at this time Under consideration AK HI TX LA FL Adopted, to be implemented 2018 Adopted Source: Kaiser Family Foundation. Data as of January Current Status of State Medicaid Expansion Decisions. Link: Chart added in Chartbook Note: AR, IA, IN, MI, MT, and NH are pursuing alternative expansion models.

27 Percent Enrollment Chart 1.26: Total Effectuated Marketplace Enrollment by Metal Level, % 4% 2% 1% 1% 6% 4% 7% 7% 11% 63% 68% 68% 71% 63% Platinum Gold Silver Bronze Catastrophic 18% 23% 23% 20% 1% 0% 1% 1% 1% 29% Sources: Centers for Medicare & Medicaid Services. Data released April Health Insurance Marketplaces Open Enrollment Period Final Enrollment Report. Link: and ASPE Issue Brief. Health Insurance Marketplace 2016 Open Enrollment Period: Final Enrollment Report. Data Released March Link: and Health Insurance Marketplaces 2017 Open Enrollment Final Enrollment Report: November 1, 2016 January 31, Chart added in Chartbook 2016.

28 Annual Percent Change Chart 1.27: Annual Change in Health Insurance Premiums, % 13.3% 13.3% 11.2% 10% 9.7% 9.7% 9.4% 9.5% 5% 5.5% 5.5% 4.7% 5.5% 3.0% 4.5% 3.9% 4.2% 3.4% 3.4% 3.0% 0% Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data released September Link: Chart 1.27 in 2015 and earlier years Chartbooks.

29 Average Operating Margins Chart 1.28: Managed Care Plan Average Operating Margins, % 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 4.9% 4.4% 3.8% 3.9% 5.8% 6.9% 7.8% 7.1% 7.5% 6.6% 6.3% 6.5% 5.6% 5.0% 5.1% 5.3% 4.8% 5.1% Source: YCharts data used for 2014 and Company documents of publicly traded managed care plans used for Represents earnings before interest and taxes over net revenues for the total service lines of the 11 largest publicly traded managed care plans. Chart 1.28 in 2015 and earlier years Chartbooks.

30 Operating Margin Chart 1.29: Operating Margins of the Top Insurers, % 8% 6% 4% 6.7% 7.3% 8.1% 8.0% 7.9% 7.9% 7.0% 5.9% 5.9% 6.7% 9.5% 8.8% 5.0% 4.5% 4.5% 2% 0% Aetna Anthem UnitedHealth Group Cigna Humana Source: YCharts data used for 2014 and Data from FactSet Research Systems Inc. used in 2012, 2013, and earlier years Chartbooks. Wellpoint in 2014 and earlier years Chartbooks. In December 2014, Wellpoint changed its name to Anthem. Chart 1.29 in 2015 and earlier years Chartbooks.