U.S. Health Care Coverage and Spending

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Updated January 26, 2021
U.S. Health Care Coverage and Spending
In 2019, the United States had an estimated population of
nonmedical net costs, which include, but are not limited to,
323 million individuals. Most of those individuals had
taxes, net gains or losses to reserves, and profits.
private health insurance or received health care services
under a federal program (such as Medicare or Medicaid).
Most of this spending was for hospital care and physician
About 9.2% of the U.S. population was uninsured.
and professional services (Figure 1). Private health
insurance spending, as a percentage of all health
Individuals (including those who were uninsured), health
consumption expenditures, has increased by about 10
insurers, and federal and state governments spent
percentage points since 1960 (Figure 2). This growth is
approximately $3.6 trillion on various types of health
partially due to increases in enrollment and, when
consumption expenditures (HCE) in 2019, which accounted
considered alongside the implementation and expansions of
for 16.8% of the nation’s gross domestic product.
Medicare and Medicaid, corresponds with the drop in out-
of-pocket spending since 1960.
Table 1. Health Care Coverage, 2019
Medicare
Enrollment
Medicare is a federal health insurance program that pays for
(millions/percentage
covered health care services for most people aged 65 and
Source
of U.S. population)
older and for certain permanently disabled individuals
Insured
293 (90.8%)
under the age of 65.
Private health insurance – Group
179 (55.4%)
An estimated 58 million individuals (18.1% of the U.S.
Private health insurance – Non-group
42 (13.1%)
population) were enrolled in Medicare in 2019. The
program accounted for $799 billion (22.2% of overall
Medicare
58 (18.1%)
HCE); this share is about 11 percentage points higher than
Medicare’s percentage of HCE in 1970 (Figure 2). In 2019,
Medicaid/CHIP
64 (19.8%)
most of the spending was for hospital care and physician
Military - TRICARE
9 (2.7%)
and professional services (Figure 1).
Military - VA Care
7 (2.2%)
Figure 1. Health Consumption Expenditures by Type
Uninsured
30 (9.2%)
and Source, 2019
(in billions of dollars)
Source: U.S. Census Bureau, Table HIC-4_ACS. Health Insurance Coverage
Status and Type of Coverage by State-Al Persons: 2008 to 2019,
September
2020.
Notes: Italicized = does not add to total. Individuals may have more than
one type of coverage at a time (for example, Medicare and Medicaid).
Therefore, estimates by type of coverage are not mutual y exclusive.
CHIP = The State Children’s Health Insurance Program. Medicaid/CHIP
coverage estimate also includes al means-tested public coverage, such as
state and local y financed public coverage.
Private Health Insurance
Private health insurance is the predominant source of health

insurance coverage in the United States. The private health
Source: Centers for Medicare and Medicaid Services, National Health
insurance market includes both the group market (largely
Expenditure Accounts—National Health Expenditures by Type of Expenditure
made up of employer-sponsored insurance) and the non-
and Program, December 2020.
group market (commonly referred to as the individual
Notes: Al of the terms used in this figure are defined in the source
market, which includes plans directly purchased from an
document, except long-term services and supports, which is defined in
insurer both on and off health insurance exchanges). In
2019, these markets covered an estimated 179 million
the text of this In Focus. DME = durable medical equipment. CHIP = The
individuals (55.4% of the U.S. population) and 42 million
State Children’s Health Insurance Program.
individuals (13.1% of the U.S. population), respectively.
Medicaid/The State Children’s Health
Insurance Program (CHIP)
In 2019, private health insurance accounted for $1,195
Medicaid is a joint federal-state program that finances the
billion (33.3% of overall HCE). Private health insurance
delivery of primary and acute medical services, as well as
expenditures (Figure 1) include amounts paid by insuring
organizations to providers and all insuring organizations’
long-term services and supports, to a diverse low-income
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U.S. Health Care Coverage and Spending
population, including children, pregnant women, adults,
Out-of-Pocket Spending
individuals with disabilities, and people aged 65 and older.
Out-of-pocket spending (other than premiums) includes all
amounts paid by the privately insured and other insured
CHIP is a means-tested program that provides health
individuals for coinsurance, deductibles, and services not
coverage to targeted low-income children and pregnant
covered by insurance. It also includes any amounts paid by
women in families that have annual income above Medicaid
the uninsured for health care goods and services. Among all
eligibility levels but have no health insurance.
individuals, out-of-pocket spending totaled $407 billion
(11.3% of total HCE) in 2019.
Figure 2. Health Consumption Expenditures (HCE) by
Source as a Percentage of Total HCE, 1960-2019
The Uninsured
Approximately 30 million individuals (9.2% of the U.S.
population) were uninsured in 2019. The uninsured rate was
relatively stable from 2008 to 2013 before dropping 6
percentage points by 2016 to 8.6% (Figure 3). This drop in
the uninsured rate corresponds with increases in non-group
coverage and Medicaid/CHIP coverage, which are
associated with the implementation of various provisions of
the Affordable Care Act (ACA; P.L. 111-148, as amended),
such as the exchanges and premium tax credits and the
Source: Centers for Medicare and Medicaid Services, National Health
Medicaid expansion. Since 2016, the uninsured rate has
Expenditure Accounts—National Health Expenditures by Type of Service and
slowly increased.
Source of Funds, CY1960-2019, December 2020.
Note: CHIP = The State Children’s Health Insurance Program.
Figure 3. Health Insurance Coverage by Source as a
Percentage of Total U.S. Population, 2008-2019
An estimated 64 million individuals (19.8% of the U.S.
population) received Medicaid or CHIP in 2019, and the
programs accounted for $633 billion (17.6% of overall
HCE). This spending is about 10 percentage points higher
than Medicaid/CHIP’s percentage of total HCE in 1970
(Figure 2). Furthermore, Medicaid spends the highest
percentage of expenditures on long-term services and
supports
, which includes (1) other health, residential, and
personal care; (2) nursing care facilities and continuing care
retirement communities; and (3) home health care (Figure
1
)
. Long-term services and supports also includes some

post-acute care (i.e., skilled care provided over a short term,
Source: U.S. Census Bureau, Table HIC-4_ACS. Health Insurance Coverage
typically after a hospitalization).
Status and Type of Coverage by State-Al Persons: 2008 to 2019, September
Military
2020.
Notes: Individuals may have more than one type of coverage at a time
Health care services for military servicemembers, veterans,
(for example, Medicare and Medicaid). Therefore, estimates by type of
and their dependents are provided by the Department of
coverage are not mutual y exclusive. CHIP = The State Children’s Health
Defense, through programs such as TRICARE, and the
Insurance Program. Medicaid/CHIP coverage estimate also includes al
Department of Veterans Affairs . In 2019, an estimated 9
means-tested public coverage, such as state and local y financed public
million individuals (2.7% of the U.S. population) had
coverage.
TRICARE and 7 million (2.2% of the U.S. population)
individuals had VA Care. Together, these departments
The cost of care for the uninsured population is accounted
accounted for $125 billion (3.5%) of total HCE.
for in multiple spending categories (Figure 1 and Figure
Other Health Services
2). Payments made by uninsured individuals for health care
services are included in the out-of-pocket total. Any
Other health care spending covers services provided
amounts received by providers that help to partially and/or
through public and private programs not listed above,
indirectly cover the cost of care for the uninsured are
including worksite health care programs, philanthropic
accounted for in corresponding source totals (e.g., Medicare
support, Indian Health Service activities, workers’
and Medicaid disproportionate share hospital payments are
compensation, general assistance, the Maternal and Child
included in program totals).
Health program, vocational rehabilitation, Substance Abuse
and Mental Health Services Administration grants, federal
For more information about federal health programs , see
and state public health activities, school health programs,
the CRS Health Care issue area page at http://www.crs.gov/
and other programs whose primary focus is the provision of
iap/health-care.
care or treatment of disease. Other health services
accounted for $434 billion (12.1% of total HCE) in 2019.
Ryan J. Rosso, Analyst in Health Care Financing
IF10830
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U.S. Health Care Coverage and Spending


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