In The News

U.S. Healthcare-Spending Growth Slowed in 2021, Federal Report Finds

Wall Street Journal | By Stephanie Armour
The analysis from the Centers for Medicare and Medicaid Services says national healthcare spending grew in 2021 to $4.3 trillion. 
Overall health spending had risen by 10.3% in 2020, and the more moderate increase last year was largely driven by a drop off in federal spending related to Covid-19. In fact, federal health spending fell 3.5% in 2021 to $1.46 trillion after surging almost 37% in 2020. At the same time, there was an uptick in spending on insurance coverage and healthcare services in 2021.
The healthcare share of the gross domestic product was 18.3% in 2021, down from 19.7% in 2020.
Medicare spending swelled 8.4% in 2021 after rising by 3.6% in 2020, with a strong rate of spending growth in Medicare private plans and increases in spending on hospital care and doctor and clinical services. 
Medicaid, a state-federal program for the low income and disabled, saw a 9.2% increase in spending in 2021. The pace was similar to 2020 but far higher than the average 2.9% rate of spending growth in the 2017 through 2019 period. The spending rate was driven by faster enrollment in Medicaid and a restriction on states’ ability to disenroll enrollees during the pandemic public-health emergency. 
Private-health-insurance spending rose 5.8% in 2021 after a decline of 1.1% in 2020, and accounted for 28% of total healthcare spending last year—an uptick largely due to more enrollment and use by consumers. Most of the growth in enrollment came from the individual market, as more people signed up for coverage because Congress passed legislation to enhance Affordable Care Act premium subsidies. Employer-sponsored health insurance saw its second consecutive year drop in enrollment. 
Out-of-pocket health spending last year rose by 10.4%, marking the fastest rate of growth since 1985, as people resumed visiting doctors and obtaining elective health procedures once the impact of the pandemic lessened. The faster growth was especially notable in dental care, which saw spending jump 18% in 2021 after a drop of 11% in 2020.
Retail-prescription-drug spending rose 7.8% to $378 billion in 2021, a brisk pace compared with the 3.7% spending growth rate in 2020. Private health insurers, Medicare, Medicaid, and consumers’ out-of-pocket spending all experienced the faster growth, with less spent on newly available generic medications compared with spending on newly available higher-priced brand name drugs. 
Overall spending on hospital care, meanwhile, rose 4.4% to $1.3 trillion in 2021 as use of services increased after Covid-19 restrictions on elective procedures and less urgent care eased. Physician and clinical services saw a 5.6% increase in spending last year as patient visits picked up again.


CDC Expands Updated COVID-19 Vaccines to Include Children Ages 6 Months through 5 Years

Following FDA action, [December 9, 2022] CDC expanded the use of updated (bivalent) COVID-19 vaccines for children ages 6 months through 5 years. Children ages 6 months through 5 years who previously completed a Moderna primary series are eligible to receive a Moderna bivalent booster 2 months after their final primary series dose. Children ages 6 months through 4 years who are currently completing a Pfizer primary series will receive a Pfizer bivalent vaccine as their third primary dose.

Updated COVID-19 vaccines are formulated to protect against some of the more recently circulating viruses.

Most importantly, COVID-19 vaccines are critical to providing ongoing protection as immunity wanes and the virus continues to mutate.

The vast majority of children in this age group have not received any doses of a COVID-19 vaccine. CDC is working to increase parent and provider confidence in COVID-19 vaccines and improve uptake among the 95% of children who are not vaccinated or who have not completed the COVID-19 vaccine primary series. Parents should talk to their child’s health care provider to ensure their child is up to date on their COVID-19 and other vaccines.


HHS Releases Policies to Make Coverage More Accessible and Expand Behavioral Health Care Access for Millions of Americans in 2024

The Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality health care options for millions of consumers. The proposed rule would increase access to health care services, simplify choice and improve the plan selection process, and reduce consumer barriers.

“The Biden-Harris Administration has taken historic action to expand access to health care, and the Affordable Care Act Marketplace provides millions of Americans vital coverage,” said HHS Secretary Xavier Becerra. “As we make a final push now during Open Enrollment, we are encouraged that so many people are signing up for Marketplace health plans. Already we are working to build on this success.”

“We know that access to affordable health care is a concern across the nation. During the first several weeks of Affordable Care Act Marketplace Open Enrollment, we have already seen 5.5 million people select a Marketplace health plan, an 18% increase compared to last year” said CMS Administrator Chiquita Brooks-LaSure. “Continuing to propose policies that help make it easier for consumers to choose and maintain the health coverage that best fits their needs is vital. If finalized, this proposed rule does just that.”

Increasing access to health care services

The Biden-Harris Administration has made expanding access to behavioral health care a top priority. As part of that effort, the proposed rule includes two new major essential community provider (ECP) categories that are critical to delivering needed behavioral health care: Substance Use Disorder Treatment Centers and Mental Health Facilities. The rule also furthers access to providers by including a proposal to extend the current overall 35% provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers. These changes, in conjunction with a proposal to expand Network Adequacy requirements, would increase provider choice, advance health equity, and expand access to care for consumers who have low income, complex or chronic health care conditions, and/or who reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with provider network status and limited access to providers.

Simplifying choice and improving the plan selection process

In response to public feedback, the rule includes proposals to make it easier for consumers to pick a health plan that best fits their needs and budget by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by qualified health plans (QHPs) through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs). The average number of plans available to consumers on the Marketplace has increased from 27.1 in PY2019 to 131.4 in PY2023. Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings. Streamlining the plan selection process would make it easier for consumers to evaluate plan choices available on the Marketplaces and to select a health plan that best fits their unique health needs.

Making it easier to enroll in coverage

The proposed rule would give the Marketplaces the option to implement a special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan. CMS believes that this new proposed special rule would help mitigate coverage gaps when consumers lose Medicaid or CHIP while allowing for a more seamless transition into Marketplace coverage…

Read Full Press Release

For more information on the proposed rule, consult the fact sheet.

To review the Notice of Benefit and Payment Parameters for 2024 Proposed Rule, visit the CMS website. The 45-day public comment period will begin once published in the Federal Register.  


Long COVID: New Research and the Economic Toll

The urgency of the ongoing threat of COVID was highlighted this week when the CDC reported that more than 3,500 Americans have died, at least in part, due to long COVID. Watch our recent webinar to hear experts discuss long COVID and hear about ongoing research to help fill the knowledge gap about this emerging illness. In this webinar panelists discussed:

  • The current research on long COVID, including hypothesized etiologies of Post-Acute Sequelae of SARS-CoV-2.
  • A health plan’s efforts to use data and focus group discussions to understand how long COVID is impacting members and develop care management approaches.
  • The economic burden of long COVID, the need to make accommodations for workers with long COVID, and the importance of prioritizing low wage workers.  

View Recording and Panelist Slides


U.S. Congress Could Punt Funding Bill into 2023, McConnell Says

Reuters / By David Morgan and Moira Warburton

WASHINGTON, Dec 6 (Reuters) - The U.S. Congress may be forced to delay until early 2023 final agreement on funding the government through the end of its fiscal year, instead relying on a stopgap measure to keep the lights on, the top Senate Republican said on Tuesday.

The federal government is currently set to run out of money on Dec. 16 without a vote on either an "omnibus" bill funding the government through Sept. 30, 2023, or a short-term bill known as a "continuing resolution," or CR.

"We're running out of time, and that may end up being the only option left that we could agree to pursue," Senate Republican leader Mitch McConnell told reporters a day after meeting his Democratic counterpart Chuck Schumer to discuss a comprehensive omnibus package.

"We don't have agreements to do virtually anything," McConnell said. "We don't even have an overall agreement on how much we want to spend."

An omnibus bill would be expected to exceed the $1.5 trillion funding package Congress approved last March. Senator Richard Shelby, the top Republican appropriator, said the two sides were about $25 billion apart, which he described as "pretty close."

McConnell spoke the day after House Republican leader Kevin McCarthy told Fox News negotiators should hold off until January, when the new Congress with a slim Republican majority in the House is sworn in.

A Republican congressional aide, who asked for anonymity to describe intra-party dynamics, said McCarthy's warning was meant to pressure Democrats to move forward on an omnibus deal. The aide added that McCarthy has privately backed a longer-term bill to avoid a funding stand-off early in 2023.

Schumer acknowledged that there was still "a lot of negotiating left to do" to get an omnibus bill.

"Leader McConnell and I have agreed to try and work together to make sure we get a year-long omnibus funding bill done. We hope it can be done this year," Schumer told reporters.

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