American Health Care Initiative

American Health Care: Rethinking the Challenges, Opportunities, and Possibilities is a collaborative initiative between the Committee for a Responsible Federal Budget and the Concerned Actuaries Group dedicated to informing the public, policymakers, and key stakeholders regarding the fiscal and managerial challenges confronting our health care system. This effort seeks to encourage a broader and more informed discussion about why the system is costly and not working to maximum capacity.

Through this initiative, the two organizations will each publish and promote a series of papers, briefings, presentations, and other materials to energize a much needed conversation about improving the sustainability and accessibility of our health care system and managing the rising costs that threaten our current system.

Press Release:

Committee for a Responsible Federal Budget and Concerned Actuaries Group Launch Collaborative Public Dialogue on American Health Care

Committee for a Responsible Federal Budget:

Health Spending and the Federal Budget

The United States spends more on health care than any other country in the world, and a large share of that spending comes from the federal government. Over time, costs are expected to grow and consume an increasing share of federal resources. Over the long term, the rising cost of federal health care spending is clearly unsustainable. Without a course correction, the result will be program insolvency, crowding out of important public priorities, and a growing federal debt. Given how central health care spending is to the federal budget, it is important to understand how that spending is distributed and how it will grow. This paper provides background on major health care programs in the federal budget.

Analysis of the 2018 Medicare Trustees' Report

The Medicare Trustees have released their 2018 report on the financial status of Medicare. The Trustees show that Medicare spending is projected to increase significantly as a share of GDP over the next few decades, and the Hospital Insurance trust fund will be exhausted by 2026. Medicare spending growth could be even higher if multiple payment policies that hold down cost growth that may not be sustainable over the long term. This paper summarizes of the findings of the 2018 Medicare Trustees Report.

Medicare Advantage Proposal Reforms Benefits and the Bidding Process

Authors at the USC-Brookings Schaeffer Initiative for Health Policy have proposed to reform Medicare Advantage benefit design and the bidding process in a way that they estimate would save $10 billion annually. This blog summarizes the current Medicare Advantage system and the details of how the proposal would reform it.

Health Care Spending in the Long-Term Outlook

The Congressional Budget Office's long-term outlook shows federal debt increasing significantly over the next 30 years, and the growth of health care spending is a major factor in that trend. CBO projects that health care spending will increase from 5.2 percent of GDP to 9.2 percent between 2018 and 2048. This blog breaks down the spending growth that CBO projects and the reasons for it and compares CBO's projections for Medicare to those made by the Medicare Trustees.

CMS Takes Some Steps to Improve Medicare Payments

The Center for Medicare and Medicaid Services (CMS) recently proposed several new Medicare payment rules aimed at reducing costs and improving quality and efficiency of care. In particular, rules to tighten site-neutral payments for clinic visits, reduce outpatient drug payments that are based on wholesale acquisition cost, and transition Accountable Care Organizations (ACOs) into two-sided risk models could improve the efficiency of the Medicare program. At the same time, a few other rules regarding coding changes for evaluation and management and tele-health services have the potential to increase costs or reduce quality. This blog details the content of the CMS rules and how they could affect the functioning of Medicare.

Momentum for Lower Drug Prices Emerging

The Center for Medicare and Medicaid Services (CMS) recently announced plans to issue a proposed rule to test a new model for reimbursing Medicare Part B drugs. The model would base reimbursements on an International Pricing Index (IPI) that is based on other countries' drug prices and would use private vendors as an intermediary rather than reimbursing physicians directly for drugs. In addition, Congress has passed a law and proposed another bill that would take steps to reduce barriers to biosimilar and generic competition for biologic and brand-name drugs. This blog discusses the possible implications of the CMS rule and the details of the bills Congress has proposed.

Health Spending Outlook Shows Faster Growth Ahead

The Center for Medicare and Medicaid Services (CMS) recently released new National Health Expenditure (NHE) projections through 2027, showing health spending growing slower than the economy this year but growing faster than the economy every year after that. NHEs will dip slightly as a share of GDP from 18 to 17.8 percent between 2017 and 2019 but rise to 19.4 percent of GDP by 2027. This blog discusses overall projected health spending growth, how these projections compare to previous ones, and specific trends within the overall numbers.

Concerned Actuaries Group:

Big Numbers

Not enough of the current health care dialogue is focused on improving the quality, availability, and management of health care. Critical to this conversation is recognizing the magnitude of the numbers involved in American health care and understanding how that magnitude affects both the nation’s physical and financial health.

Big Benefits

The U.S. health care system includes several different payers who make substantial benefit payments to finance health care, and the ways they do that also affect how the system operates. Big Benefits, the second program from the Concerned Actuaries Group in the American Health Care Initiative looks at the relationship between benefits, usage, and costs in the health care system.

Who Pays

An important of aspect of health care in the U.S. is who pays for it and how they do it. The Concerned Actuaries Group's third program in the American Health Care Initiative discusses the allocation and management of public and private costs and payments.


Committee for a Responsible Federal Budget Health Care Page

Concerned Actuaries Group Website