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Congressional Budget Office Health Care Spending Today and in the Future: Impacts on Federal Deficits and Debt Presentation to a Conference Organized by the Center for Sustainable Health Spending, Washington, DC July 18, 2017 Jessica Banthin Deputy Assistant Director For more details, see CBO, The 2017 Long-Term Budget Outlook (March 2017), www.cbo.gov/publication/52480
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Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

May 28, 2018

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Page 1: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

Congressional Budget Office

Health Care Spending Today and in the Future:Impacts on Federal Deficits and Debt

Presentation to a Conference Organized by the Center for Sustainable Health Spending, Washington, DC

July 18, 2017

Jessica Banthin

Deputy Assistant Director

For more details, see CBO, The 2017 Long-Term Budget Outlook (March 2017), www.cbo.gov/publication/52480

Page 2: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

1CO NGRES S IO NA L BUDGE T O F F IC E

An Overview of the Long-Term Budget Outlook

Page 3: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

2CO NGRES S IO NA L BUDGE T O F F IC E

If current laws governing taxes and spending did not change, the condition of the federal budget would worsen considerably over the next three decades.

Page 4: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

3CO NGRES S IO NA L BUDGE T O F F IC E

Growth in federal spending would continue to outpace growth in federal revenues, leading to ever larger budget deficits.

Page 5: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

4CO NGRES S IO NA L BUDGE T O F F IC E

Federal Spending and Revenues

Percentage of Gross Domestic Product

Actual Projected

Page 6: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

5CO NGRES S IO NA L BUDGE T O F F IC E

As a result, debt would grow larger in relation to the economy than ever recorded in U.S. history.

Page 7: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

6CO NGRES S IO NA L BUDGE T O F F IC E

Federal Debt Held by the Public

Percentage of Gross Domestic Product

Page 8: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

7CO NGRES S IO NA L BUDGE T O F F IC E

Federal spending is projected to rise notably in relation to the economy because of growth in spending on Social Security, the major health care programs, and interest on the government’s debt.

Page 9: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

8CO NGRES S IO NA L BUDGE T O F F IC E

Components of Federal Spending

Percentage of Gross Domestic Product

0

5

10

15

2000 2005 2010 2015 2020 2025 2030 2035 2040 2045

Major Health Care Programs

Other Noninterest Spending

Social Security

Net Interest

ProjectedActual

Page 10: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

9CO NGRES S IO NA L BUDGE T O F F IC E

Health Care Spending Today

Page 11: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

10CO NGRES S IO NA L BUDGE T O F F IC E

National Spending for Health Care, 2015

1

5 6

Medicare

Page 12: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

11CO NGRES S IO NA L BUDGE T O F F IC E

CBO defines outlays for the major health care programs as spending for:

• Medicare,

• Medicaid,

• Children’s Health Insurance Program (CHIP), and

• Subsidies for health insurance purchased through the marketplaces established under the Affordable Care Act and related spending.

Page 13: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

12CO NGRES S IO NA L BUDGE T O F F IC E

Net Outlays for Major Health Care Programs in 2017

Medicare 590

Medicaid 385

Health Insurance Subsidies and Related Spending 51

Children's Health Insurance Program 15____________

Total 1,041

Billions of Dollars

Page 14: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

13CO NGRES S IO NA L BUDGE T O F F IC E

Health Care Spending in the Long-Term Budget Outlook

Page 15: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

14CO NGRES S IO NA L BUDGE T O F F IC E

If current laws generally remain unchanged, CBO projects that federal spending on the major health care programs would grow larger than any other category of spending.

Page 16: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

15CO NGRES S IO NA L BUDGE T O F F IC E

Spending in the Past and Under CBO’s Extended Baseline

Percentage of Gross Domestic Product

Page 17: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

16CO NGRES S IO NA L BUDGE T O F F IC E

Spending on the major health care programs would account for 40 percent of federal noninterest spending in 2047, compared with 28 percent today.

Page 18: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

17CO NGRES S IO NA L BUDGE T O F F IC E

Composition of Federal Noninterest Spending Under CBO’s Extended Baseline

Percent

Page 19: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

18CO NGRES S IO NA L BUDGE T O F F IC E

Spending on Medicare is projected to drive much of the growth in spending on major health care programs.

Page 20: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

19CO NGRES S IO NA L BUDGE T O F F IC E

Federal Spending on the Major Health Care Programs, by Category

Percentage of Gross Domestic Product

Projected

Page 21: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

20CO NGRES S IO NA L BUDGE T O F F IC E

Two factors explain the projected growth in spending on major health care programs: aging and rising health care costs per person, or excess cost growth.

Page 22: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

21CO NGRES S IO NA L BUDGE T O F F IC E

Projected Spending Growth in the Major Health Care Programs

Percentage of Gross Domestic Product

Page 23: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

22CO NGRES S IO NA L BUDGE T O F F IC E

Population, by Age GroupMillions of People

Page 24: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

23CO NGRES S IO NA L BUDGE T O F F IC E

Uncertainty in the Long-Term Projection

Page 25: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

24CO NGRES S IO NA L BUDGE T O F F IC E

Even if future tax and spending policies matched the policies specified under current law, budgetary outcomes would undoubtedly differ from CBO’s projections because of changes in the economy, demographics, and other factors, such as excess cost growth.

Page 26: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

25CO NGRES S IO NA L BUDGE T O F F IC E

Federal Debt Given Different Rates of Excess Cost Growth for Federal Spending on Medicare and Medicaid

Percentage of Gross Domestic Product

0

50

100

150

200

250

2000 2005 2010 2015 2020 2025 2030 2035 2040 2045

206

150

109

Actual ProjectedGiven Rates 1 Percentage Point Higher

Extended Baseline, With Excess Cost Growth of 1 Percent in 2047

Given Rates 1 Percentage Point Lower

Page 27: Congressional Budget Office - Altarumaltarum.org/sites/default/files/uploaded-related-files/Banthin.pdf · Congressional Budget Office Health Care Spending Today and in the Future:

26CO NGRES S IO NA L BUDGE T O F F IC E

This presentation will be available on CBO’s website, www.cbo.gov.