CMS Releases 1991-2014 Health Care Spending by State

CMS Releases 1991-2014 Health Care Spending by State

Data details health care spending for residents by service and major payer

Today, the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014. The data shows that while most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates. The report also found that the most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage. Every state experienced slower growth in per capita personal health care spending from 2010-2013 than experienced during the period 2004-2009.

David Lassman, the lead author of the report noted that, “recent economic and health  sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal health care expenditure growth; however, during the 2009 to 2014 period, the variation in spending between the lowest and highest states was virtually unchanged.”

The report, published as a web first in Health Affairs, offers vital context for understanding how health spending varies across states. The analysis updates previous estimates published in 2011 and examines personal health care spending (or the health care goods and services consumed) through a resident-based view. These estimates are also presented both by type of goods and services (such as hospital services and retail prescription drugs) and by major payer (including Medicare, Medicaid, and private health insurance) for the individuals who reside in a state.

The topline findings from the report include:

  • Considerable regional variation on personal health care spending:
    • In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($10,119 and $9,370, respectively), or 26 and 16 percent higher than the national average ($8,045).

    • In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita in 2014 ($6,814 and $6,978, respectively) with average spending roughly 15 percent lower than the national average. 

  • Similar growth in Medicaid expansion and non-expansion states: While most states experienced faster growth in 2014 compared to 2013 due to Medicaid expansion and enrollment in Health Insurance Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates, 4.4 and 4.5 percent respectively. The similar growth in per capita spending for expansion and non-expansion states was due largely to two effects:
    • Faster growth in the use of healthcare goods and services in expansion states relative to non-expansion states due to a larger increase in the percent of people insured in those states.
    • Faster growth in spending per insured person in non-expansion states relative to expansion states.
  • Impact of recent economic recession and recovery: The most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage.
    • For 2010-2013, per capita personal health spending grew at a rate of 2.8 percent per year on average, substantially slower than during 2004-2009, when spending averaged 5.2 percent growth per year.
    • During 2010-2013, every state experienced slower growth in per capita personal health care spending with an average deceleration of just over two percentage points compared to the 2004-2009 period.
  • Three Major Payers:
    • Medicare: States with above average per enrollee Medicare spending were generally located in the eastern United States while states with the lowest spending were generally in the western United States.
      • The State with the highest per enrollee Medicare spending in 2014 was New Jersey ($12,614) with spending levels roughly 15 percent above the national average ($10,986).

      • In 2014, Montana was the State with the lowest per enrollee Medicare spending, at $8,238 per enrollee (25 percent below the national average per enrollee).

    • Medicaid: The recent trends in per enrollee spending were driven by the Medicaid coverage expansion, which increased the share of relatively less expensive enrollees relative to the previous Medicaid beneficiary population mix in expansion states.
      • Total Medicaid spending increased 12.3 percent from 2013 to 2014 for states that expanded Medicaid, compared with 6.2 percent for states that did not expand Medicaid.
      • However, on a per enrollee basis Medicaid spending declined considerably for the expansion states (-5.1 percent) in 2014, because of the enrollment of relatively less expensive enrollees, whereas per enrollee Medicaid spending in the non-expansion states increased 5.1 percent. 
    • Private Health Insurance: Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3 percent since 2009 ($3,872).
      • Total private health insurance spending grew more rapidly in states that did not expand Medicaid eligibility by 2014 than in states that did expand eligibility, at rates of 6.8 percent and 4.6 percent, respectively.
      • A majority of this difference reflects faster private health insurance enrollment growth in non-expansion states (3.2 percent) compared to that for expansion states (1.9 percent).

The OACT data and analysis will appear at:

An article about the study also being published by Health Affairs here:

Health stat in California

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A writer wrote that public health costs have soared as one-third of California residents admitted to state hospitals for any causes suffer from diabetes, a sometimes-lethal disease often predicated on poor diet, lack of exercise and excessive weight.

Connie’s  Comments:

We can reallocate health resources better, build more roads and bridges, cut high housing costs, spend more on education, vocational skills schools, pattern technical degrees to current skill set needed by tech industries and have a universal health care with wellness promotion (insurance premiums goes toward incentives for those who exercise and good food choices).
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Govt Spending Trends in the USA

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  • Despite a dislike of taxes (e.g. in 2014, 57.0% said their own federal income tax was too high, 39.0% about right, 1.6% too low, and 2.4% don’t know), more people have always favored increases in spending than cuts.
  • In 2014, as in most years since the 1970s, people have backed more spending in about four-fifths of the areas and less spending in only the bottom quintile.
  • Moreover, the number of areas with positive net spending scores not only outnumbered areas with negative scores, but are also larger. In 2014, the largest negative score (-61.7 for Foreign Aid) was bested by the top positive score (Education +66.6) and other top positive scores were well above the other negative scores.
  • The level of support has however waxed and waned over the decades.
  • Support for both overall spending and domestic social spending declined from the early 1970s to the early 1980s before rebounding to a peak in 1990.
  • Then support again fell off to lows in 1994-1996.
  • After that support again picked up with overall spending peaking in 2006 and domestic social spending topping off in 2008. Both scales fell during the economic downturn.
  • The over-spending score has started to rise again, but support for domestic social spending has not recovered.
  • Currently Education is clearly the public’s top spending priority with a very high score (+67) that is above even other very popular areas like Halting Crime, Assistance to the Poor the Environment, Social Security, Dealing with Drug Addiction, and Alternative Energy (+46 to +53).

What would the Federal Reserve do

tools what would fed do

Economic indicators: SP500, building permit, unemployment, capital goods spending, money supply

What would you do with your income and spending this 2015?

Contact Connie Dello Buono, helping doctors and business owners reduce income taxes via a business structure and financial strategies. 408-854-1883 or

Cut costs in bank fees, home/car insurance, dining, and more

Cut costs , save more

Home/Car Insurance and Financial Fees Save almost $600 a year Some credit cards sock you with fees of $30-plus, the FDIC reports, if you’re even a day late with your payment. Say you have a bad math week and bounce a check—that’s a fortune right there. Stay on top of these painful fees and save yourself from spending money that does nothing for you.

Set up an overdraft account. “Link your checking account to your savings account, so that if you overdraw, the money comes from savings, says Luke Reynolds, head of the FDIC’s community outreach efforts. Just make sure you always have a $300 cushion in your account.

Set up automatic withdrawal. Avoid late fees on your card by having your card issuer automatically withdraw the minimum amount before your due date. Many issuers also let you pay by phone. This helps during those months when you realize the due date is…today.

Don’t pay for credit reports. You know those ads promising free credit reports? Despite the catchy tune, the reports really aren’t free, notes Reynolds—they can cost about $15 per month. For a truly free report, head to You can get one free credit report each year; for most people, that’s plenty, he adds.

Cut ATM fees. Sure, having an ATM on every corner is convenient. But it’s also pricey, if you go outside your own bank’s network. Some ATMs charge $2-to-$3 per transaction. Your own bank may take on another couple bucks. If you use these once a month, that’s $60 out the window by next year. To avoid the fees, head to your bank’s website, and find the branches and ATMs near your usual stomping grounds. Make a point of using these whenever possible. What if you’re away from home and need cash? Use stores as your ATM—pay with your debit card and then ask for extra cash back when you check out, Reynolds suggests. Many times they do this without changing any fees.

Raise your deductible. The average annual bill for homeowner’s insurance was $804 in 2006, according to the Insurance Information Institute. However, by raising your deductible from $500 to $1,000, you could save up to 25 percent on your premium, the Institute says. If your annual tab is about the average, that works out to $200 per year. Same with car insurance: Kick it up from $250 to $500 and you’ll save between $171 and $257 per year, says Sam Belden, vice president with

Revisit your policy. If you’ve changed jobs, for instance, and drive less to work, you may be able to reduce your car insurance rate.  Low mileage rates, which can save you five to 15 percent, typically come into play if you drive less than about 7,500 miles each year, Belden says.

Recession proof your money

Is there a simple (and painless) way to create a budget? Most people are unreasonably afraid of the B-word. But knowing where your money goes can show you where you have room to spend, as well as where you need to cut back. It’s as easy as remembering these two numbers: 60 and 40. Sixty percent of your monthly income should go to fixed expenses such as food, mortgage or rent, utilities, transportation, and health care. Divide the remaining 40 percent as follows:

10% for a retirement fund. Yes, even if you have debt. At the very least, contribute the maximum amount to your 401(k) that your company will match–never pass up dough. 10% for paying off debt or building an emergency fund 10% for short-term savings to be spent on nonrecurring expenses like vacations or unexpected home repairs 10% for fun stuff that will improve your quality of life.


Protect your assets with an index universal life insurance with full living benefits that grows to 13% tax free, contact Connie Dello Buono, CA Life Lic 0G60621, Retirement Planner

1708 Hallmark Lane, San Jose, CA 95124