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TABLE OF CONTENTS
CHAPTER 1.0: Trends in the Overall Health Care Market
Chart 1.1: Total National Health Expenditures, 1980 – 2010
Chart 1.2: Percent Change in Total National Health Expenditures, 1990 – 2010
Chart 1.3: Per Capita National Health Expenditures, 1980 – 2010
Chart 1.4: National Health Expenditures as a Percentage of Gross Domestic Product, 1990 – 2010
Chart 1.5: National Expenditures for Health Services and Supplies by Category, 1980 and 2010
Chart 1.6: Percent Change in National Expenditures for Health Services and Supplies by Category, 2009 – 2010
Chart 1.7: Percent Change in National Expenditures for Selected Health Services and Supplies, 2000 – 2010
Chart 1.8: National Health Expenditures, 1980 – 2020
Chart 1.9: Consumer Out-of-pocket Payments for National Health Expenditures, 1990 – 2010
Chart 1.10: Total Prescription Drug Spending, 1980 – 2010
Chart 1.11: Growth in Total Prescription Drug Spending as a Percentage of Total Growth in National Health Expenditures, 1990 – 2010
Chart 1.12: Consumer Out-of-pocket Spending vs. Private Health Insurance Spending for Prescription Drugs, 1990 – 2010
Chart 1.13: Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2010
Chart 1.14: Distribution of Health Insurance Coverage, Percentage of Population Covered by Payer, 1990, 2009, and 2010
Chart 1.15: Number and Percent Uninsured, 1990 – 2010
TABLE OF CONTENTS
CHAPTER 1.0: Trends in the Overall Health Care Market
Chart 1.16: Average Percent Uninsured by State, 2008 – 2010
Chart 1.17: Medicare Enrollees, 1991 – 2011
Chart 1.18: Medicaid Enrollees, 1990, 1995, 2000 – 2011
Chart 1.19: National CHIP Enrollment, FY 1999 – FY 2010
Chart 1.20: Percent Change in CHIP Enrollment By State, FY 2009 – FY 2010
Chart 1.21: Percentage of Employees with Employer-based Coverage Who CanChoose Conventional, PPO, HMO, POS, and HDHP/SO Plans, 1988 – 2011
Chart 1.22: Distribution of Employer-sponsored Health Insurance Enrollment by Type of Plan, 1988 – 2011
Chart 1.23: Percentage of Medicare Beneficiaries Enrolled in Medicare Managed Care, 1991 – 2011
Chart 1.24: Percent Growth in Medicare Spending per Beneficiary vs. Private Health Insurance Spending per Enrollee, 1990 – 2010
Chart 1.25: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care, 1992 – 2010
Chart 1.26: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care by State, 2010
Chart 1.27: Annual Change in Health Insurance Premiums, 2000 – 2011
Chart 1.28: Managed Care Plan Median Operating Margins, 1997 – 2011
Chart 1.29: Operating Margins of the Top Insurers, 2009 – 2011
$200
$700
$1,200
$1,700
$2,200
$2,700
$3,200
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 08 09 10
Bill
ions
Inf lation Adjusted(2)
Chart 1.1: Total National Health Expenditures, 1980 – 2010(1)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.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, 1990 – 2010 (1)
11.9
%
9.3%
8.4%
7.4%
5.6%
5.6%
5.3% 5.6%
5.8% 6.4% 7.0%
8.5% 9.
5%
8.4%
7.1%
6.8%
6.6%
6.2%
4.7%
3.8%
3.9%
0%
5%
10%
15%
20%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Per
cent
Cha
nge
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.3: Per Capita National Health Expenditures, 1980 – 2010(1)
Inflation Adjusted(2)
$200
$1,200
$2,200
$3,200
$4,200
$5,200
$6,200
$7,200
$8,200
$9,200
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 08 09 10
Per
Cap
ita A
mou
nt
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(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, 1990 – 2010(1)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
12.5
%
13.2
%
13.5
%
13.8
%
13.7
%
13.9
%
13.8
%
13.7
%
13.7
%
13.8
%
13.8
%
14.5
%
15.4
%
15.9
%
16.0
%
16.1
%
16.2
%
16.4
%
16.8
%
17.9
%
17.9
%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Per
cent
age
of G
DP
Chart 1.5: National Expenditures for Health Services and Supplies(1) by Category, 1980 and 2010(2)
Hospital Care, 42.6% Hospital Care, 33.3%
Physician Services, 20.2%Physician Services, 21.1%
Other Professional,(4) 7.2%
Other Professional,(4) 7.1%
Home Health Care, 1.0%
Home Health Care, 2.9%
Prescription Drugs, 5.1%Prescription Drugs, 10.6%
Other Medical Durables and Non-durables, 5.9% Other Medical Durables and
Non-durables, 3.3%
Nursing Home Care, 6.5%Nursing Home Care, 5.9%
Other,(3) 11.5% Other,(3) 15.8%
1980 2010Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.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.
$235.7B $2,444.6B
6.2%7.2%
1.2%
4.9%
6.4%
2.5% 2.8% 3.2%
4.7%All Health Services & Supplies, 4.0%
-3%
-1%
1%
3%
5%
7%
9%
Home Health Care
Admin. & Net Cost of Private
Health Insurance
Prescription Drugs
Hospital Care Other Physician Services
Other Professional
Nursing Home Care
Other Medical Durables and Non-durables
Pe
rce
nt C
ha
ng
eChart 1.6: Percent Change in National Expenditures for Health Services and Supplies(1) by Category, 2009 – 2010(2)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(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, 2000 – 2010(1)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Hospital Care
Prescription DrugsAdmin. & Net Cost of Private
Health Insurance
Home Health Care
Nursing Home Care
-5%
0%
5%
10%
15%
20%
25%
00 01 02 03 04 05 06 07 08 09 10
Per
cent
Cha
nge
Chart 1.8: National Health Expenditures,(1) 1980 – 2021(2)
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
80 90 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
Bill
ions
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released June 2012.(1) Years 2011 – 2021 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.9: Consumer Out-of-pocket Payments for National Health Expenditures, 1990 – 2010(1)
$0
$40
$80
$120
$160
$200
$240
$280
$320
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Bill
ions
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.10: Total Prescription Drug Spending, 1980 – 2010(1)
Inflation Adjusted(2)
$0
$40
$80
$120
$160
$200
$240
$280
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 08 09 10
Bill
ions
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(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, 1990 – 2010(1)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
0%
5%
10%
15%
20%
25%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Per
cent
age
of T
otal
Gro
wth
Chart 1.12: Consumer Out-of-pocket Spending vs. Private Health Insurance Spending for Prescription Drugs, 1990 – 2010(1)
Out-of -pocket
Private Health Insurance
$0
$10
$20
$30
$40
$50
$60
$70
$80
$90
$100
$110
$120
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Bill
ions
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.13: Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2010(1)
Medicare, 14.6% Medicare, 16.3% Medicare, 20.2%
Total Medicaid, 10.2%Total Medicaid, 14.8%
Total Medicaid, 16.0%Other Government, 17.5%
Other Government, 14.5%Other Government, 13.8%
Private Insurance, 27.0%
Private Insurance, 33.4% Private Insurance, 32.7%Other Private, 7.9%
Other Private, 6.3%Other Private, 5.7%
Out-of-pocket, 22.8%Out-of-pocket, 14.7% Out-of-pocket, 11.6%
1980 2000 2010
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
$255.8B $2,593.6B$1,377.2B
Chart 1.14: Distribution of Health Insurance Coverage, Percentage of Population Covered by Payer, 1990, 2009, and 2010
16.3%
4.2%
15.9%
14.5%
64.0%
16.7%
4.1%
15.7%
14.3%
63.9%
13.9%
4.0%
9.7%
13.0%
73.2%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Uninsured
Other Government
Medicaid
Medicare
Private
1990 2009 2010
Source: US Census Bureau, Current Population Survey, 2011 Annual and Social Economic Supplement. Data released February 2011. Table HIB-4. Health Insurance Coverage Status and Type of Coverage by State All People: 1999 to 2010.Link: http://www.census.gov/hhes/www/hlthins/data/historical/files/hihistt4B.xls.
Chart 1.15: Number and Percent Uninsured, 1990 – 2010
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
0
5
10
15
20
25
30
35
40
45
50
55
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Per
cent
of
Tot
al P
opul
atio
n
Num
ber
of U
nins
ured
(M
illio
ns)
Number Percent
Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2010. Data released August2011. Table 8. People Without Health Insurance Coverage by Selected Characteristics: 2009 and 2010. Link: http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/table8.pdf.
Chart 1.16: Average Percent Uninsured by State, 2008 – 2010
< 10.0%
10.0% - 14.9%
15.0% - 19.9%
20.0%
RI 11.5%DE 11.7%DC 11.4%
Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2010. Data released August2011. Link: http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/state.xls.
Chart 1.17: Medicare Enrollees,(1) 1991 – 2011
Source: Centers for Medicare & Medicaid Services. Medicare Enrollment: National Trends, 1966 – 2005; Medicare Aged and Disabled Enrollees by Type of Coverage. CMS, Office of the Actuary. Email correspondence with CMS staff (for years 2001 – 2011).(1) Hospital insurance (Part A) enrollees and/or Supplementary Medical Insurance (Part B) enrollees; includes all persons (aged and
disabled).
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
44.4
45.5
46.6
47.7
48.7
0
5
10
15
20
25
30
35
40
45
50
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11
Mill
ions
Chart 1.18: Medicaid Enrollees,(1) 1990, 1995, 2000 – 2011
Aged
Blind/Disabled
Children
Adults
Other Title XIX
25.3
36.3
44.548.4
50.9 52.457.3 58.6 60.9 60.5 62.1
67.8 67.7 69.5
0
10
20
30
40
50
60
70
80
1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Mill
ion
s
Source: Congressional Budget Office. Data released February 2011. Spending and Enrollment Detail for CBO’s March 2011 Baseline: Medicaid. Link: http://www.cbo.gov/budget/factsheets/2011b/medicaid.pdf. (1) Does not include CHIP Enrollees.
Chart 1.19: National CHIP Enrollment,(1, 2) FY 1999 – FY 2010
1,959,330
3,333,879
4,622,204
5,353,812 5,984,772 6,102,784 6,151,215
6,745,1947,097,584
7,355,7467,695,264 7,705,723
FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010
Source: Centers for Medicare & Medicaid Services. Data released February 2011. Number of Children Ever Enrolledby Program Type. Link: http://www.cms.hhs.gov/NationalCHIPPolicy/downloads/CHIPEverEnrolledYearGraph.pdf.(1) 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.
Chart 1.20: Percent Change in CHIP Enrollment by State, FY 2009 – FY 2010(1)
Source: Centers for Medicare & Medicaid Services. Data released February 2011. Number of Children Ever Enrolledby Program Type. Link: http://www.cms.gov/NationalCHIPPolicy/downloads/FY2010StateCHIPTotalTable_020111_FINAL.pdf.(1) 2009 figure reflects revised data released by Centers for Medicare & Medicaid Services on February 1, 2011.
RI 19%DE 2%DC -13%
10% - 19%
1% - 9%
<0%
20% - 29%
30%
0%
20%
40%
60%
80%
100%
1988 1996 1999 2002 2005 2006 2007 2008 2009 2010 2011
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 – 2011
(2)
Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2011. Employer Health Benefits: 1999, 2002, 2005, 2006, 2007, 2008, 2009, 2010, 2011. Link: http://ehbs.kff.org/pdf/2011/8225.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 – 2011
Conventional
PPO
HMO
POS
HDHP/SO
0%
20%
40%
60%
80%
100%
1988 1996 1999 2002 2005 2006 2007 2008 2009 2010 2011
(2)
(3)
(1)
Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2011. Employer Health Benefits: 1999, 2002, 2005, 2006, 2007, 2008, 2009, 2010, 2011. Link: http://ehbs.kff.org/pdf/2011/8225.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.
Chart 1.23: Percentage of Medicare Beneficiaries Enrolled in Medicare Managed Care,1991 – 2011
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Email correspondence with CMS staff in January 2012.
4% 4%
5%
6%
8%
10%
13%
16% 17
%
17%
15%
13%
12%
12% 13
%
17%
20% 22
% 24% 25
%
25%
0%
3%
6%
9%
12%
15%
18%
21%
24%
27%
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11
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, 1990 – 2010(1,2)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.(1) 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 http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf.
(2) Data reflects spending on benefits commonly covered by Medicare and Private Health Insurance.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Private Health Insurance
Medicare
Chart 1.25: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care, 1992 – 2010
12% 14%
23%29%
40%
48%54% 56% 56% 57% 58% 59%
61%63% 65% 64%
71% 72% 71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
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, 2010.
Chart 1.26: Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care by State, 2010
25% - 49%
50% - 74%
75% - 100%
1% - 24%
0%
RI 67.4%DE 77.4%DC 69.7%
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment Report as of June 30, 2010.
Chart 1.27: Annual Change in Health Insurance Premiums, 2000 – 2011
11.2%
9.7%
13.3% 13.3%
9.7% 9.4%
5.5% 5.5%4.7%
5.5%
3.0%
9.5%
0%
4%
8%
12%
16%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Ann
ual P
erce
nt C
hang
e
Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2011. Link: http://ehbs.kff.org/pdf/2011/8225.pdf.
Chart 1.28: Managed Care Plan Median Operating Margins,(1) 1997 – 2011
Source: Company documents of publicly traded managed care plans.(1) Represents earnings before interest and taxes over net revenues for the total service lines of the11 largest publicly traded managed care plans.
4.9%4.4%
3.8% 3.9%
4.9%
5.8%
6.9%
7.8%
6.6%7.1%
7.5%
5.6%5.0%
6.3% 6.5%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Med
ian
Ope
ratin
g M
argi
ns
Chart 1.29: Operating Margins of the Top Insurers, 2009 – 2011
Source: FactSet Research Systems Inc. Data for all years updated as of March 2012. Data from Hoovers used in 2011 and earlier years’ Chartbooks.
0%
2%
4%
6%
8%
10%
12%
14%
Aetna WellPoint UnitedHealth Group
Cigna Humana
Ope
ratin
g M
argi
n
2009 2010 2011
