Posted: 3:32 p.m. Wednesday, Sept. 18, 2013
By Jordan Rau
The nation’s total health spending will bump up next year as the health law expands insurance coverage to more Americans, and then will grow by an average of 5.8 percent a year over the next decade, according to projections released Wednesday by government actuaries.
That estimate is lower than typical annual increases before the recession hit. Still, the actuaries forecast that in a decade, the health care segment of the nation’s economy will be larger than it is today, amounting to a fifth of the gross domestic product in 2022.
They attributed that to the rising number of baby boomers moving into Medicare and the actuaries’ expectation that the economy will improve, according to their findings published in the journal Health Affairs.
The actuaries were not persuaded that experiments in the health law and new insurer procedures that change the way doctors, hospitals and others provide services will significantly curtain health spending. They assumed "modest" savings from those changes from the law. "It's a little early to tell how substantial those savings will be in the longer term," Gigi Cuckler, one of the actuaries, told reporters.
The actuaries also said they are skeptical that the nation has entered a new era of lower health spending, a case that has been made by the Obama administration and many prominent economists. They have predicted a strengthening economy will not be accompanied by sharp health spending hikes. The report expects health spending will rise faster than economic growth as the business climate improves. "Until we see evidence that relationship has been broken, it's very difficult to conclude something structural has occurred," Stephen Heffler, director of the statistics group at Office of the Actuary at the Centers for Medicaid and Medicare, told reporters.
The actuaries predict that by the end of this year, then nation will have spent 4 percent more than in 2012. That would be an unusually low increase by historic standards because the economy has remained "sluggish" and employers are making workers pick up more of the costs of medical services, driving down use. The nation will spend $2.9 trillion this year on health services, they predict.
Next year the actuaries expect about 11 million uninsured people will gain coverage through the new private insurance marketplaces and the expansion of Medicaid that starts under the federal health law. Health spending will rise by 6.1 percent to $3.1 trillion, the actuaries estimated, particularly driven by higher use of physician and other medical professional services and higher prescription drug use. The actuaries expect most of the newly insured people will be relatively young and healthy, and therefore spending on hospitals and other acute services will not rise as much.
The health law's limits on the maximum amount patients will be required to spend will lead out-of-pocket spending to fall 1.5 percent in 2014. That will reverse course again in future years, primarily because people will have more disposable income as the economy improves, but the actuaries do not believe out-of-pocket spending will rise as quickly as overall health spending.
Over the decade, government spending will be tempered by reductions in spending on Medicare and Medicaid driven by the automatic 2 percent cuts in federal spending, known as sequestration, and lower payments Medicare is imposing on providers, the actuaries said. Still, government programs will be responsible for medical coverage for more people than they are now. By 2022, health spending will total $5 trillion, which is 19.9 percent of the gross domestic product, up from 17.9 percent last year, according to the estimates.
The Obama administration enthusiastically greeted the report. "We are on the right track to controlling health care costs, thanks in part to the Affordable Care Act," CMS Administrator Marilyn Tavenner said in a statement. "More Americans will have the ability to get the health care they need, and that is a good thing. We have identified several areas where our reforms to control costs are making progress and we must build on those efforts in the years ahead."
James Capretta, a budget adviser to President George W. Bush, disagreed. "I think it's quite clear from the study that the notion that the health care law fundamentally bends costs is just totally unsupported by facts," he said in an interview. "Something more fundamental needs to be done to slow costs than what is in the health law."
Uwe Reinhardt, a Princeton economist, said, "I also believe the ACA had basically nothing to do with the bending of the cost curve in the last few years." But he said he was more optimistic that health spending will not resume its old path of sharp increases. "I do believe there is a mood among the payers for harder pushback on prices," he added in a podcast discussion about the report recorded by Health Affairs.
"It's quite astounding" that the actuaries do not expect health care providers to hike their prices in coming years, he said. "Most of the increases they project have to do with more insured and the growth of the elderly because of the retiring baby boom."
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.