Medicaid’s Share of National Health Spending: 5 Key Facts
Okay, here’s a breakdown of the key data from the provided text, focusing on the National Health Expenditure (NHE) data and how KFF (Kaiser Family Foundation) uses it:
What is the National Health Expenditure (NHE) Data?
Comprehensive: It’s a complete accounting of all health care spending in the US – goods, services, and investment in the health care sector.
Sources: Data comes from a variety of sources: federal administrative data, surveys of households, businesses, and economic data from the Bureau of Labor Statistics and the Bureau of Economic Analysis.
Medicaid Specifics: Medicaid spending is primarily based on financial reports (Form CMS-64), with durable medical equipment estimates using person-level payment data.
Methodology: Detailed documentation is available from CMS (https://www.cms.gov/files/document/definitions-sources-and-methods.pdf and https://www.cms.gov/files/document/quick-definitions-national-health-expenditures-accounts-nhea-categories.pdf).
Link to Historical Data: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical
how KFF Uses the NHE Data:
Enrollment Analysis: KFF uses NHE data to estimate Medicaid’s share of total health insurance enrollment. They use MSIS data (2000-2013) and CMS-64 projections (2014-2023). Total enrollment includes private insurance, Medicare, Medicaid, CHIP, and VA/dod.
Personal Health Care Services: KFF analyzes spending on these services (revenue received by providers), excluding administrative costs, public health activities, and investments in infrastructure. They use service categories like hospitals, providers, and prescription drugs as defined by the NHEA, with a slight exception for Long-Term Care.
Spending by Payer: KFF categorizes spending based on who is paying for the health care. Here’s how they define the key payer categories:
Medicaid: state and federal spending on fee-for-service and managed care, but excludes CHIP.
medicare: Parts A, B, C (Medicare Advantage), D, and Part D within Medicare Advantage. Excludes private supplemental insurance like Medigap and employer-sponsored Part D (those are included in “Private Insurance”). Private Insurance: Fully-insured plans, self-insured employer plans, ACA marketplace plans, indemnity plans, and supplemental Medicare plans (like Medigap).
Out-of-Pocket: Direct consumer spending (coinsurance, deductibles, etc.).
In essence, KFF relies on the NHE data as a foundational source for understanding health care spending trends in the US, breaking it down by service type and payer source. They use specific definitions and methodologies consistent with the NHE Accounts data, while sometimes making minor adjustments for their own analyses (like with Long-Term Care).