16 Jun Where Does Your State Stand With Regard to Health Care Spending?

This week, the Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary released a report analyzing health care spending data broken down at the state level for the period between 1991 – 2014.  We were interested in sharing some highlights of this report with our readers, especially at a time when we’re potentially on the cusp of major health care legislative changes that could result in significant changes to health care spending.

CMS summarized some of the key findings in the report:


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. 


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 report included some excellent graphs that provide a big picture view of health care spending by state:

State Spending Blog

*Source: Health Affairs


The following table contains some interesting income and personal health spending data broken down by region.

Exhibit 4

*Source: Health Affairs

For the full study: http://content.healthaffairs.org/content/early/2017/06/13/hlthaff.2017.0416

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