Health care spend­ing sta­bi­lized in Trump’s first year in of­fice.

Ac­tu­ar­ies said con­sumers went for generic drugs

The Washington Times Daily - - FRONT PAGE - BY TOM HOW­ELL JR.

Health care spend­ing sta­bi­lized dur­ing Pres­i­dent Trump’s first year in of­fice, as pa­tients used fewer ser­vices, Oba­macare’s im­pact waned and pa­tients no longer needed pricey hep­ati­tis C drugs, fed­eral ac­tu­ar­ies said Thurs­day.

Con­sumers also found more low-cost gener­ics at the phar­macy counter, while fewer pain medicines flew off the shelves, as pol­i­cy­mak­ers started to get a han­dle on the ad­dic­tion cri­sis, ac­cord­ing to the Cen­ters for Medi­care and Med­i­caid Ser­vices.

Na­tional health spend­ing grew at a rate of 3.9 per­cent in 2017, nearly a full per­cent­age point slower than in the pre­vi­ous year.

To be sure, health spend­ing in raw dol­lars con­tin­ues to climb. It inched up to $3.5 tril­lion last year, or about $10,700 per per­son.

Yet the rate of growth, which con­tin­ues a slow­down that be­gan in 2016, aligned closely with eco­nomic growth, mean­ing health spend­ing’s share of the gross do­mes­tic prod­uct re­mained static at about 18 per­cent.

“This was the first year since 2013 that this share did not in­crease,” CMS wrote in Health Af­fairs, which pub­lished the re­port.

Ac­tu­ar­ies said they don’t know if a slow­down in the use of hospi­tals, doc­tor’s ser­vices and re­tail drugs was at­trib­ut­able to a health­ier pop­u­la­tion, though they pointed to a few trends that may ex­plain the slower growth in ex­pen­di­tures.

Hep­ati­tis C suf­fer­ers who snapped up pricey, brand-name drugs at mid-decade have been cured and no longer need the ther­a­pies. The medicines, which can cost $1,000 per pill, made a big splash when they en­tered the mar­ket and fu­eled the de­bate over high-cost drugs.

Amer­i­cans also are spend­ing less on pain med­i­ca­tion, since doc­tors are be­ing more cau­tious about pre­scrib­ing the ad­dic­tive pills.

“A lot of that did have to do with the opi­oid epi­demic and greater tight­en­ing of those types of pre­scrip­tions be­ing dis­pensed,” said Anne Martin, a CMS ac­tu­ary and lead au­thor of the re­port.

The opi­oid pre­scrib­ing rate fell to its low­est rate in more than 10 years in 2017, at 58.7 pre­scrip­tions per 100 per­sons, ac­cord­ing to the Cen­ters for Dis­ease Control and Preven­tion.

Slower growth in health in­sur­ance en­roll­ment is likely hold­ing back spend­ing, too. The share of in­sured per­sons in the U.S. dipped slightly, from 91.1 per­cent to 90.9 per­cent, from 2016 to 2017, the re­port said.

In­ter­est in Oba­macare plans on the ex­changes slipped, and the di­rect pur­chase of in­sur­ance out­side of the law’s ex­changes fell in the face of soar­ing pre­mi­ums that un­sub­si­dized cus­tomers couldn’t af­ford.

Mean­while, the vast ex­pan­sion of Med­i­caid in­sur­ance for the poor stalled out in the states by 2017, when Repub­li­cans took control of both Congress and the White House on a pledge to undo the pro­gram.

Those ef­forts fell apart, how­ever, re­new­ing in­ter­est in Med­i­caid ex­pan­sion that may be re­flected in fu­ture cost re­ports.

Vir­ginia is im­ple­ment­ing its ex­pan­sion now, while Maine and three con­ser­va­tive-lean­ing states that ap­proved ex­pan­sion via the bal­lot box are poised to ex­pand their rolls next year.

What did change in CMS’ re­port, how­ever, is the share of costs borne by states. The fed­eral gov­ern­ment paid the full cost of the Med­i­caid-ex­pan­sion pop­u­la­tion un­til 2017, when states had to start pay­ing 5 per­cent of the costs — a share that will in­crease to 10 per­cent start­ing in 2020.

CMS’ re­port says state and lo­cal spend­ing on Med­i­caid grew by 6.4 per­cent in 2017, while fed­eral ex­pen­di­tures grew just 0.8 per­cent.

Spend­ing on Medi­care, the pro­gram for se­niors that ac­counts for one-fifth of health spend­ing, grew by slightly more than 4 per­cent — about the same rate as in 2016.

AS­SO­CI­ATED PRESS

Un­der Pres­i­dent Trump, health care spend­ing sta­bi­lized, fed­eral ac­tu­ar­ies said on Thurs­day. They said they don’t know if a slow­down in the use of hospi­tals, doc­tor’s ser­vices and re­tail drugs was at­trib­ut­able to a health­ier pop­u­la­tion.

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