TABLE OF CONTENTS CHAPTER 1.0: Trends in the Overall Health Care Market Chart 1.1: Total National Health Expenditures, 1980 – 2007 Chart 1.2: Percent

TABLE OF CONTENTS

CHAPTER 1.0: Trends in the Overall Health Care Market

Chart 1.1: Total National Health Expenditures, 1980 – 2007

Chart 1.2: Percent Change in Total National Health Expenditures, 1987 – 2007

Chart 1.3: Per Capita National Health Expenditures, 1980 – 2007

Chart 1.4: National Health Expenditures as a Percentage of Gross Domestic Product, 1987 – 2007

Chart 1.5: National Expenditures for Health Services and Supplies by Category, 1980 and 2007

Chart 1.6: Percent Change in National Expenditures for Health Services and Supplies by Category, 2006 – 2007

Chart 1.7: Percent Change in National Expenditures for Selected Health Services and Supplies, 1997 – 2007

Chart 1.8: National Health Expenditures, 1980 – 2018

Chart 1.9: Consumer Out-of-pocket Payments for National Health Expenditures, 1990 – 2007

Chart 1.10: Total Prescription Drug Spending, 1980 – 2007

Chart 1.11: Growth in Total Prescription Drug Spending as a Percentage of Total Growth in National Health Expenditures, 1987 – 2007

Chart 1.12: Consumer Out-of-pocket Spending vs. Private Health Insurance Spending for Prescription Drugs, 1987 – 2007

Chart 1.13: Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2007

Chart 1.14: Distribution of Health Insurance Coverage, Percentage of Population Covered by Payer, 1990, 2006, and 2007

Chart 1.15: Number and Percent Uninsured, 1987 - 2007

TABLE OF CONTENTS

CHAPTER 1.0: Trends in the Overall Health Care Market

Chart 1.16: Average Percent Uninsured by State, 2005 – 2007

Chart 1.17: Medicare Enrollees, 1988 – 2008

Chart 1.18: Medicaid Enrollees, 1990, 1995, 2000 – 2007

Chart 1.19: National SCHIP Enrollment, FY 1999 – FY 2007

Chart 1.20: Percent Change in SCHIP Enrollment By State, FY 2006 – FY 2007

Chart 1.21: Percentage of Employees with Employer-based Coverage Who CanChoose Conventional, PPO, HMO, POS, and HDHP/SO Plans, 1988 – 2008

Chart 1.22: Distribution of Employer-sponsored Health Insurance Enrollment by Type of Plan, 1988 – 2008

Chart 1.23: Percentage of Medicare Beneficiaries Enrolled in Medicare Managed Care, 1991 – 2008

Chart 1.24: Percent Growth in Medicare Spending per Beneficiary vs. Private Health Insurance Spending per Enrollee, 1987 – 2007

Chart 1.25: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care, 1992 – 2007

Chart 1.26: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care by State, 2007

Chart 1.27: Annual Change in Health Insurance Premiums, 1998 – 2008

Chart 1.28: HMO Plan Median Operating Margins, 1990 – 2006

Chart 1.29: Operating Margins of the Top Insurers, 2005 – 2007

Chart 1.1: Total National Health Expenditures, 1980 – 2007(1)

Inflation Adjusted(2)

$200

$700

$1,200

$1,700

$2,200

$2,700

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Bill

ions

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2009.(1) CMS completed a benchmark revision in 2006, 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 http://www.cms.hhs.gov/NationalHealthExpendData/downloads/benchmark.pdf.

(2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.

Chart 1.2: Percent Change in Total National Health Expenditures, 1987 – 2007(1)

8.9%

11.9

%

11.3

%

11.8

%

9.4%

8.6%

7.5%

5.4%

5.6%

5.1%

5.3% 5.8% 6.3% 7.

0%

8.6% 9.0%

8.3%

6.9%

6.8%

6.7%

6.1%

0%

5%

10%

15%

20%

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Per

cent

Cha

nge



Chart 1.3: Per Capita National Health Expenditures, 1980 – 2007(1)


$200

$1,200

$2,200

$3,200

$4,200

$5,200

$6,200

$7,200

$8,200

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Per

Cap

ita A

mou

nt



(2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.

Chart 1.4: National Health Expenditures as a Percentage of Gross Domestic Product, 1987 – 2007(1)



10.8

%

11.2

%

11.6

%

12.3

%

13.0

%

13.4

%

13.7

%

13.6

%

13.7

%

13.7

%

13.6

%

13.6

%

13.7

%

13.8

%

14.5

%

15.3

%

15.8

%

15.9

%

15.9

%

16.0

%

16.2

%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Per

cent

age

of G

DP

Chart 1.5: National Expenditures for Health Services and Supplies(1) by Category, 1980 and 2007(2)

Hospital Care, 43.3%Hospital Care, 33.2%

Physician Services, 20.2%

Physician Services, 22.8%

Other Professional(4), 7.3%Other Professional(4), 7.5%

Home Health Care, 1.0%Home Health Care, 2.8%

Prescription Drugs, 5.2% Prescription Drugs, 10.8%

Other Medical Durables and Non-durables, 5.8%Other Medical Durables and Non-durables, 2.9%

Nursing Home Care, 7.9%Nursing Home Care, 6.3%

Other(3), 9.4% Other(3), 13.6%

1980 2007

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2009.(1) Excludes medical research and medical facilities construction.(2) CMS completed a benchmark revision in 2006, 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 http://www.cms.hhs.gov/NationalHealthExpendData/downloads/benchmark.pdf.(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.

$233.4B $2,098.1B

Chart 1.6: Percent Change in National Expenditures for Health Services and Supplies(1) by Category, 2006 – 2007(2)

11.3%

7.3%

4.9%

3.7%

5.4%4.8%

3.6%

6.5%6.1%

All Health Services & Supplies, 6.2%

0%

2%

4%

6%

8%

10%

12%

Home HealthCare

Admin. & NetCost of

P rivate HealthInsurance

P rescriptionDrugs

Hospital Care Other P hysicianServices

OtherP rofessional

NursingHome Care

Other MedicalDurables andNon-durables

Per

cent

Cha

nge

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2009.(1) Excludes medical research and medical facilities construction.(2) CMS completed a benchmark revision in 2006, introducing changes in methods, definitions and source data that are


(3) “Other” includes government public health activities and other personal health care.(4) “Other professional” includes dental and other non-physician professional services.

(3)(4)

Chart 1.7: Percent Change in National Expenditures for Selected Health Services and Supplies, 1997 – 2007(1)



Hospital Care

Prescription Drugs

Admin. & Net Cost of Private Health Insurance

Home Health Care

Nursing Home Care

-5%

0%

5%

10%

15%

20%

97 98 99 00 01 02 03 04 05 06 07

Per

cent

Cha

nge

Chart 1.8: National Health Expenditures(1), 1980 – 2018(2)

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released February 23, 2009.(1) Years 2008 – 2018 are projections.(2) CMS completed a benchmark revision in 2006, introducing changes in methods, definitions and source data that are


$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

80 90 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

Bill

ions

Chart 1.9: Consumer Out-of-pocket Payments for National Health Expenditures, 1990 – 2007(1)



$0

$40

$80

$120

$160

$200

$240

$280

90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Bill

ions

Chart 1.10: Total Prescription Drug Spending, 1980 – 2007(1)


$0

$40

$80

$120

$160

$200

$240

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Bill

ions



(2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for All Urban Consumers.

Chart 1.11: Growth in Total Prescription Drug Spending as a Percentage of Total Growth in National Health Expenditures, 1987 – 2007(1)



0%

5%

10%

15%

20%

25%

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Per

cent

age

of T

otal

Gro

wth

Chart 1.12: Consumer Out-of-pocket Spending vs. Private Health Insurance Spending for Prescription Drugs, 1987 – 2007(1)

Out-of-pocket

Private Health Insurance

$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

$100

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Bill

ions



Chart 1.13: Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2007(1)

Medicare, 19.2%Medicare, 16.6%Medicare, 14.7%

Total Medicaid, 14.7%Total Medicaid, 14.8%

Total Medicaid, 10.3%

Other Government, 12.3%Other Government, 12.7%Other Government, 17.0%

P rivate Insurance, 34.6%P rivate Insurance, 33.6%

P rivate Insurance, 27.2%

Other P rivate, 7.2%Other P rivate, 8.1%

Other P rivate, 7.9%

Out-of-pocket, 12.0%Out-of-pocket, 14.2%Out-of-pocket, 22.9%

1980 2000 2007



$253.4B $2,241.2B$1,353.2B

Chart 1.14: Distribution of Health Insurance Coverage, Percentage of Population Covered by Payer, 1990, 2006, and 2007

3.7%

13.2%

13.8%

15.8%

3.6%

12.9%

4.0%

13.0%

73.2%

15.3%

67.5%

13.6%

67.9%

13.9%

9.7%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Uninsured

Other Government

Medicaid

Medicare

Private

1990 2006 2007

Source: US Census Bureau, Current Population Survey, 2008 Annual and Social Economic Supplement. Data released March 2008. Table HI05. Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2007. Link: http://pubdb3.census.gov/macro/032008/health/h05_000.htm.

Chart 1.15: Number and Percent Uninsured, 1987 – 2007

0

5

10

15

20

25

30

35

40

45

50

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Num

ber

of U

nins

ured

(M

illio

ns)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Per

cent

of

Tot

al P

opul

atio

n

Number Percent

Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2007. Data released August2008. Table 6. People Without Health Insurance Coverage by Selected Characteristics: 2006 and 2007. Link:http://www.census.gov/hhes/www/hlthins/hlthin07/p60no235_table6.pdf.

Chart 1.16: Average Percent Uninsured by State, 2005 – 2007

< 10.0%

10.0% - 14.9%

15.0% - 19.9%

20.0%

RI 10.3%DE 11.8%DC 11.4%

Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2007. Data released August2008. Link: http://www.census.gov/hhes/www/hlthins/hlthin07/p60no235_table8.pdf.

Chart 1.17: Medicare Enrollees,(1) 1988 – 2008

Source: Centers for Medicare & Medicaid Services. Medicare Enrollment: National Trends, 1966 – 2005; Medicare Aged and Disabled Enrollees by Type of Coverage. Link: http://www.cms.hhs.gov/MedicareEnRpts/Downloads/HISMI05.pdf (for years 1988 – 2000). CMS, Office of the Actuary. Email correspondence with CMS staff (for years 2001 – 2008).(1) Hospital insurance (Part A) enrollees and/or Supplementary Medical Insurance (Part B) enrollees; includes all persons (aged and

disabled).

33.0

33.6

34.2

34.9

35.6

36.3

36.9

37.5

38.1

38.4

38.8

39.1

39.7

40.1

40.5

41.2

41.9

42.6

43.4

44.1

44.9

0

5

10

15

20

25

30

35

40

45

88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

Mill

ions

Chart 1.18: Medicaid Enrollees,(1) 1990, 1995, 2000 – 2007

25.3

36.3

44.548.4

50.9

57.3 58.660.9 60.5

Aged

Blind/Disabled

Children

Adults

Other Title XIX

52.4

0

10

20

30

40

50

60

70

1990 1995 2000 2001 2002 2003 2004 2005 2006 2007

Mill

ion

s

Source: Congressional Budget Office. Data released March 2008. Fact Sheet for CBO’s March 2008 Baseline: Medicaid.Link: http://www.cbo.gov/budget/factsheets/2008b/medicaidBaseline.pdf.(1) Does not include SCHIP Enrollees.

Chart 1.19: National SCHIP Enrollment,(1,2) FY 1999 – FY 2007

1,959,330

3,333,879

4,622,204

5,353,812

5,984,772 6,102,784 6,151,215

6,745,1947,144,794

FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007

Source: Centers for Medicare & Medicaid Services. Data released February 2008. Number of Children Ever Enrolledby Program Type. Link:http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/SCHIPEverEnrolledYEARFY2007FINAL.PDF.(1) Number of children enrolled at any point in the year.(2) 2006 figure reflects revised data released by Centers for Medicare & Medicaid Services on February 7, 2008.

Chart 1.20: Percent Change in SCHIP Enrollment by State, FY 2006 – FY 2007(1)

Source: Centers for Medicare & Medicaid Services. Data released February 2008. Number of Children Ever Enrolledby Program Type. (1) 2006 figures reflect revised data released by Centers for Medicare & Medicaid Services on February 7, 2008.

RI 2%DE 4%DC 4%

10% - 19%

1% - 9%

0%

20% - 29%

30%

Unknown

0%

20%

40%

60%

80%

100%

1988 1996 1999 2002 2005 2006 2007 2008

Conventional PPO HMO POS HDHP/SO

Chart 1.21: Percentage of Employees with Employer-based Coverage Who Can Choose Conventional, PPO, HMO, POS, and HDHP/SO Plans, 1988 – 2008

(2)

Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2008. Employer Health Benefits: 1999, 2002, 2005, 2006, 2007, 2008. Link: http://ehbs.kff.org/pdf/7790.pdf. KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1996. (1) Conventional plans refer to traditional indemnity plans.(2) Point-of-service plans not separately identified in 1988. (3) In 2006, the survey began asking about HDHP/SO, high deductible health plans with a savings option.

(3)(1)

Chart 1.22: Distribution of Employer-sponsored Health Insurance Enrollment by Type of Plan, 1988 – 2008

The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2008. Employer Health Benefits: 1999, 2002, 2005, 2006, 2007, 2008. Link: http://ehbs.kff.org/pdf/7790.pdf. KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1996.(1) Conventional plans refer to traditional indemnity plans.(2) Point-of-service plans not separately identified in 1988. (3) In 2006, the survey began asking about HDHP/SO, high deductible health plans with a savings option.

Conventional

PPO

HMO

POS

HDHP/SO

0%

20%

40%

60%

80%

100%

1988 1996 1999 2002 2005 2006 2007 2008

(2)

(3)

(1)

Chart 1.23: Percentage of Medicare Beneficiaries Enrolled in Medicare Managed Care,1991 – 2008

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Email correspondence with CMS staff in January 2009.

4% 4%

5%

6%

8%

10%

13%

16% 17

%

17%

15%

13%

12%

12% 13

%

16%

20%

23%

0%

3%

6%

9%

12%

15%

18%

21%

24%

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

Per

cent

age

of B

enef

icia

ries

Chart 1.24: Percent Growth in Medicare Spending per Beneficiary vs. Private Health Insurance Spending per Enrollee, 1987 – 2007(1,2)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07



(2) Data reflects spending on benefits commonly covered by Medicare and Private Health Insurance.

Private Health Insurance

Medicare

Chart 1.25: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care, 1992 – 2007

12% 14%

23%

29%

40%

48%

54% 56% 56% 57% 58% 59%63% 65% 64%

61%

0%

10%

20%

30%

40%

50%

60%

70%

92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Per

cent

age

of B

enef

icia

ries

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment Report as of June 30, 2007. Data for 2007 updated per correspondence with CMS in September 2008.

Chart 1.26: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care by State, 2007

25% - 49%

50% - 74%

75% - 100%

1% - 24%

0%

RI 63.1%DE 66.9%DC 64.7%

Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment Report as of June 30, 2007. Data for 2007 updated per email correspondence with CMS in September 2008.

Chart 1.27: Annual Change in Health Insurance Premiums for Family Coverage, 1999 – 2008

11.2%

9.7%

13.3% 13.3%

9.7% 9.4%

5.5% 5.5%4.7%

0%

4%

8%

12%

16%

2000 2001 2002 2003 2004 2005 2006 2007 2008

Ann

ual P

erce

nt C

hang

e

Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2008. Employer Health Benefits: 2008. Link: http://ehbs.kff.org/pdf/7790.pdf.

Chart 1.28: HMO Plan Median Operating Margins, 1990 – 2006

Source: Health Leaders-Interstudy, The Health Leaders-Interstudy Competitive Edge: Part II: Managed CareIndustry Report, using data as of January 1, 2007.

2.1% 2.2%2.5% 2.4%

1.2%

-0.9%

-3.5% -3.5%

-1.3%

-0.6%

1.2%

2.8%

3.5%

2.7% 2.7%

-0.05%

2.1%

-4%

-3%

-2%

-1%

0%

1%

2%

3%

4%

90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Med

ian

Ope

ratin

g M

argi

n

Chart 1.29: Operating Margins of the Top Insurers, 2005 – 2007

Source: Hoovers. Data for all years updated as of February 2009. Link: www.hoovers.com.

0%

2%

4%

6%

8%

10%

12%

14%

Aetna WellPoint UnitedHealthGroup

Cigna Humana

Op

era

ting

Ma

rgin

2005 2006 2007

Documents

TABLE OF CONTENTS CHAPTER 1.0: Trends in the Overall Health Care Market Chart 1.1: Total National Health Expenditures, 1980 – 2007 Chart 1.2: Percent