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Presentation at a Trustee Briefing of the Committee for Economic
Development of The Conference Board
May 16, 2023
Carrie Colla
Director, Health Analysis Division
Federal Health Spending Update
For information about the meeting, see www.ced.org/people/trustees/briefings-public.
2
The Budgetary Context
3
Congressional Budget Office, An Update to the Budget Outlook: 2023 to 2033 (May 2023), www.cbo.gov/publication/59096. Years are fiscal years. Primary deficits exclude net outlays
for interest.
Total Deficits, Primary Deficits, and Net Interest Outlays
In CBO’s updated
projections, net interest
outlays increase by
1.1 percent of GDP from
2023 to 2033 and are the
main contributor to the
growth of total deficits.
Primary deficits decrease by
0.1 percent of GDP over that
period.
Percentage of Gross Domestic Product
4
Health Care in the Budget
5
Data source: Centers for Medicare & Medicaid Services.
National Health Expenditures
Health care spending in the
United States has grown
over time. Since 1960, it has
more than tripled as a
percentage of GDP.
0
5
10
15
20
25
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020
Percentage of Gross Domestic Product
6
Congressional Budget Office, The 2022 Long-Term Budget Outlook (July 2022), www.cbo.gov/publication/57971.
Federal Spending, by Category
Over the long term, net
spending for interest and
outlays for the major health
care programs and Social
Security are projected to rise
in relation to GDP; other
spending, in total, is
projected to decline.
7
Projected
0
2
4
6
8
10
2008 2013 2018 2023 2028 2033 2038 2043 2048 2053
Medicaid, CHIP, and
Marketplace Subsidies
Medicare
Percentage of Gross Domestic Product
Data source: Congressional Budget Office. Years are fiscal years. FY = fiscal year; CHIP = Children’s Health Insurance Program.
Federal Outlays for Major Health Care Programs
Projections for Major Health
Care Programs for FY 2023
Billions of Dollars
Medicare 820
Medicaid 589
Marketplace Subsidies 81
Children’s Health
Insurance Program 18
8
Congressional Budget Office, Federal Subsidies for Health Insurance Coverage for People Under 65: 2022 to 2032 (June 2022), www.cbo.gov/publication/57962.
Subsidies for Employment-Based Health Insurance Coverage
As a percentage of GDP,
federal subsidies for
employment-based
coverage are projected to
grow over the coming
decade.
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032
Percentage of Gross Domestic Product
9
Health Policy After the Pandemic
10
Ongoing Analysis
§ Budget baseline
– Impact of the coronavirus pandemic
– Demographics (fertility, mortality)
§ Insurance coverage
§ Projections of health care spending
Recent Reports
§ A description of who was uninsured in 2019
and why
§ Review of health care prices by payer
§ Single-payer series: budget impact,
financing, macroeconomic impact
§ Drug prices and innovation
Recent Analysis of Legislation,
Including Cost Estimates
§ Surprise billing
§ Legislation in response to the pandemic
– Medicaid continuous coverage
– Timing of the public health emergency
§ Expansion of Affordable Care Act (ACA)
subsidies in the American Rescue Plan Act
(ARPA)
§ Medicare expansions: dental, vision,
hearing
§ Drug price negotiation
§ Redesign of Medicare Part D benefit
§ Immunosuppressant drugs
Types of CBO Products About Health Care
11
§ Demand for services
§ Telehealth
§ Workforce issues and their role in supply of care
§ Mental health and substance use
§ Continuous eligibility and redetermination in Medicaid
§ Other issues
Post-Pandemic Issues CBO is Monitoring

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Federal Health Spending Update

  • 1. Presentation at a Trustee Briefing of the Committee for Economic Development of The Conference Board May 16, 2023 Carrie Colla Director, Health Analysis Division Federal Health Spending Update For information about the meeting, see www.ced.org/people/trustees/briefings-public.
  • 3. 3 Congressional Budget Office, An Update to the Budget Outlook: 2023 to 2033 (May 2023), www.cbo.gov/publication/59096. Years are fiscal years. Primary deficits exclude net outlays for interest. Total Deficits, Primary Deficits, and Net Interest Outlays In CBO’s updated projections, net interest outlays increase by 1.1 percent of GDP from 2023 to 2033 and are the main contributor to the growth of total deficits. Primary deficits decrease by 0.1 percent of GDP over that period. Percentage of Gross Domestic Product
  • 4. 4 Health Care in the Budget
  • 5. 5 Data source: Centers for Medicare & Medicaid Services. National Health Expenditures Health care spending in the United States has grown over time. Since 1960, it has more than tripled as a percentage of GDP. 0 5 10 15 20 25 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 Percentage of Gross Domestic Product
  • 6. 6 Congressional Budget Office, The 2022 Long-Term Budget Outlook (July 2022), www.cbo.gov/publication/57971. Federal Spending, by Category Over the long term, net spending for interest and outlays for the major health care programs and Social Security are projected to rise in relation to GDP; other spending, in total, is projected to decline.
  • 7. 7 Projected 0 2 4 6 8 10 2008 2013 2018 2023 2028 2033 2038 2043 2048 2053 Medicaid, CHIP, and Marketplace Subsidies Medicare Percentage of Gross Domestic Product Data source: Congressional Budget Office. Years are fiscal years. FY = fiscal year; CHIP = Children’s Health Insurance Program. Federal Outlays for Major Health Care Programs Projections for Major Health Care Programs for FY 2023 Billions of Dollars Medicare 820 Medicaid 589 Marketplace Subsidies 81 Children’s Health Insurance Program 18
  • 8. 8 Congressional Budget Office, Federal Subsidies for Health Insurance Coverage for People Under 65: 2022 to 2032 (June 2022), www.cbo.gov/publication/57962. Subsidies for Employment-Based Health Insurance Coverage As a percentage of GDP, federal subsidies for employment-based coverage are projected to grow over the coming decade. 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Percentage of Gross Domestic Product
  • 9. 9 Health Policy After the Pandemic
  • 10. 10 Ongoing Analysis § Budget baseline – Impact of the coronavirus pandemic – Demographics (fertility, mortality) § Insurance coverage § Projections of health care spending Recent Reports § A description of who was uninsured in 2019 and why § Review of health care prices by payer § Single-payer series: budget impact, financing, macroeconomic impact § Drug prices and innovation Recent Analysis of Legislation, Including Cost Estimates § Surprise billing § Legislation in response to the pandemic – Medicaid continuous coverage – Timing of the public health emergency § Expansion of Affordable Care Act (ACA) subsidies in the American Rescue Plan Act (ARPA) § Medicare expansions: dental, vision, hearing § Drug price negotiation § Redesign of Medicare Part D benefit § Immunosuppressant drugs Types of CBO Products About Health Care
  • 11. 11 § Demand for services § Telehealth § Workforce issues and their role in supply of care § Mental health and substance use § Continuous eligibility and redetermination in Medicaid § Other issues Post-Pandemic Issues CBO is Monitoring