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Costs & Spending

Exhibit 2

National health expenditures (NHE) and health insurance enrollment, aggregate and per enrollee amounts, and average annual growth, by source of funds, selected calendar years 2021 – 32

Projected

Source of funds

2021

2022

2023

2024

2026

2032

Expenditure, billions Private health insurance

$1,218.3

$1,289.8

$1,433.5 1,023.9

$1,550.3 1,086.0

$1,671.3 1,246.1

$2,216.8 1,936.9 1,334.7

Medicare Medicaid

892.1 735.4

944.3 805.7

851.9

833.5

930.4

Per enrollee spending Private health insurance

$6,067 14,266

$6,330 14,814

$6,838 15,689

$7,247 16,316 10,292

$7,965 17,873 11,524

$10,576 24,921 15,632

Medicare Medicaid

8,681

8,873

9,336

Enrollment, millions Private health insurance

200.8

203.8

209.6

213.9

209.8

209.6

Medicare Medicaid Uninsured Population

62.5 84.7 28.5

63.7 90.8 26.6

65.3 91.2 22.8

66.6 81.0 24.4

69.7 80.7 29.6

77.7 85.4 32.8

329.6

330.9

332.7

334.9

339.3

351.4

Insured share of total population

91.4%

92.0%

93.1%

92.7%

91.3%

90.7%

2021 a

2022

2023

2024

2025 – 26

2027 – 32

Average annual growth Expenditure Private health insurance

2.7%

5.9%

11.1%

8.1%

3.8%

4.8%

Medicare Medicaid

5.4 9.3

5.9 9.6

8.4 5.7

6.1

7.1 5.7

7.6 6.2

− 2.2

Per enrollee expenditure Private health insurance

3.0%

4.3%

8.0%

6.0%

4.8%

4.8%

Medicare Medicaid

3.5 1.4

3.8 2.2

5.9 5.2

4.0

4.7 5.8

5.7 5.2

10.2

Enrollment Private health insurance

− 0.3%

− 1.0%

1.5%

2.9%

2.0%

0.0%

Medicare Medicaid Uninsured Population

1.9 7.8

1.9 7.2

2.4 0.5

2.0

2.3

1.8 0.9 1.7 0.6

− 11.2

− 0.2 10.1

− 5.3

− 6.6

− 14.2

6.9 0.7

0.3

0.4

0.6

0.6

SOURCE Centers for Medicare and Medicaid Services (CMS), Office of the Actuary, National Health Statistics Group. NOTES Definitions, sources, and methods for NHE categories can be found in CMS. National Health Expenditure Accounts: methodology paper (see the exhibit 1 notes). Numbers might not add to totals because of rounding. Percent changes are calculated from unrounded data. Tables with data for all years of the projection period can be found in CMS.gov. NHE projections tables (see note 1 in text). a Reflects annual growth for 2019 – 21 to average the volatile impacts of the first two years of the COVID-19 pandemic.

affect spending trends for Parts B and D of the Medicare program and for Medicare beneficia ries, based on provisions that change the Part D benefit ’ s cost-sharing requirements, allow the Department of Health and Human Services to negotiate prices for several expensive medica tions, and link certain pharmaceutical price in creases to the Consumer Price Index. Among the major payers, Medicare has the highest projected ten-year average spending growth rate, at 7.4 percent, whereas the growth rates for private health insurance (5.6 percent), Medicaid (5.2 percent), and out-of-pocket (4.7 percent) expenditures are projected to be comparatively lower (calculable from exhibit 3). Medicare ’ s higher average spending growth in 2023 – 32 is mainly due to the program ’ s average

projected enrollment growth rate of 2.0 percent, which reflects the enrollment of the baby-boom generation through 2029; in comparison, aver age projected enrollment growth is lower for private health insurance, at 0.3 percent, and it declines by 0.6 percent for Medicaid, an outcome associated with the end of the public health emergency (calculable from exhibit 2). For private health insurance, greater variation in the projected year-to-year spending trends in the early portion of the projection period reflects rebounding growth in per enrollee spending in 2023 that results from faster growth in the use of health care services and goods. During 2023 – 25, private health insurance enrollment is expected to increase by 8.3 million in direct-purchase health insurance coverage, followed by a pro

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Health Affairs July 2024 43:7

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