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As an eventful decade for health care draws to a close, it's fun to think back a decade to all the fighting over what was going to happen to health care costs under the Affordable Care Act. I'm reminded of two bookends:
The buzzkill scenario put out by the Office of the Actuary at CMS in April 2010 ("Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended ") predicted health spending would be pushed up slightly relative to baseline and we'd be spending over $4.7 trillion on health care this year.
The rosiest in-the-tank-for-Obamacare scenario, put out in May 2010 in a joint Center for American Progress/Commonwealth Fund publication authored by the '08 Obama campaign's health advisor, predicted impressive savings relative to baseline ("The Impact of Health Reform on Health System Spending") that would help us keep health spending down to $4.3 trillion this year.
Funny now to look back at what happened next.
*Estimated pending final data. Actuals for 2010-18 are: 4.3% average annual growth, $3.6 trillion in spending in 2018, and health care at 17.7% of GDP in 2018.
If you had predicted those actuals a decade ago, you would've been laughed out of the conversation. Health care cost grown slowed down well beyond what anyone was predicting back then.
The buzzkill scenario put out by the Office of the Actuary at CMS in April 2010 ("Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended ") predicted health spending would be pushed up slightly relative to baseline and we'd be spending over $4.7 trillion on health care this year.
The rosiest in-the-tank-for-Obamacare scenario, put out in May 2010 in a joint Center for American Progress/Commonwealth Fund publication authored by the '08 Obama campaign's health advisor, predicted impressive savings relative to baseline ("The Impact of Health Reform on Health System Spending") that would help us keep health spending down to $4.3 trillion this year.
Funny now to look back at what happened next.
Buzzkill scenario | Rosy scenario | What actually happened* | |
Avg annual health spending growth rate, 2010-19 | 6.6% | 5.7% | 4.4% |
Cumulative health savings relative to baseline, 2010-19 | -$311 billion | $590 billion | $2.7 trillion |
Total health spending in 2019 | $4.7 trillion | $4.3 trillion | $3.8 trillion |
Health spending as a percentage of GDP in 2019 | 21.0% | Not projected | 17.8% |
If you had predicted those actuals a decade ago, you would've been laughed out of the conversation. Health care cost grown slowed down well beyond what anyone was predicting back then.