1. V e r m o n t Legislative Joint Fiscal Office Growth in Health Care Spending: A comparison of Vermont and the U.S. Nolan Langweil, Legislative Joint Fiscal Office January 18, 2008

2. V e r m o n t Legislative Joint Fiscal Office Data CMS, Office of the Actuary (2006 data) BISHCA, Expenditure Analysis (2006 data) –Note: FY2005 and earlier uses unadjusted numbers

3. V e r m o n t Legislative Joint Fiscal Office UNITED STATES $7,092 Per Capita VERMONT $6,321 Per Capita Per Capita Spending 2006

4. V e r m o n t Legislative Joint Fiscal Office Trends in Growth: 1996-2006 UNITED STATES from $910B to $1.76T 6.8% average annual growth VERMONT from $1.7B to $3.9B 8.6% average annual growth

5. V e r m o n t Legislative Joint Fiscal Office Trends in Growth: 1996-2006 Overall health care expenditure trends for Vermont and the U.S. are fairly comparable.

6. V e r m o n t Legislative Joint Fiscal Office Trends in Growth: 1996-2006 1)Hospital care 2)Physicians & Clinical svcs 3)Drugs & Supplies 1)Hospital care 2)Physicians & Clinical svcs 3)Drugs & Supplies

7. V e r m o n t Legislative Joint Fiscal Office Growth when comparing third-party payer by sector (EXCLUDES DRUGS) Trends in Growth: 1996-2006

8. V e r m o n t Legislative Joint Fiscal Office Growth when comparing third-party payer by sector (INCLUDES DRUGS) Trends in Growth: 1996-2006

9. V e r m o n t Legislative Joint Fiscal Office PAYER$ (By % of total expenditures) U.SPAYERVERMONT 21.6%Medicare18.1% 16.2%Medicaid23.7% 14.6%Out-of-pocket12.5% 36.0%Private Insurance (total) 41.4 Other payers include: State & Local, Other Federal, etc.

10. V e r m o n t Legislative Joint Fiscal Office MEDICARE Trends in Growth: 1996-2006 Largest single payer of health care services in the U.S. –21% of personal health care spending –Medicaid was second largest (16%) 2 nd largest payer in Vermont –18% of health spending –Medicaid was largest (24%)

11. V e r m o n t Legislative Joint Fiscal Office MEDICARE Trends in Growth: 1996-2006 Both US and VT: Largest increase in $ spent were in 1) Hospital care, 2) physician & clinical svs and 3) Drugs (in that order) Combined they represent: –US = 84% of total Medicare Spending –VT = 77% of total Medicare Spending –Hospital Care accounted for half of Medicare spending in both VT and the U.S. 2006

12. V e r m o n t Legislative Joint Fiscal Office MEDICARE Drugs as % of overall Medicare spending: 20052006 U.S. 1.2% ($4B) 10.3% ($39.4B) VT <1% ($4,000) 11% (78.8M)

13. V e r m o n t Legislative Joint Fiscal Office MEDICARE Medicare Part D Before Part D After Part D Overall Spending on DRUGS by Payer (Vermont):

14. V e r m o n t Legislative Joint Fiscal Office MEDICARE Medicare Part D Medicaid & Out-of-pocket drug spending saw decreases 20052006 MEDICAID VT = $146M US = $37B VT* = $78M US = $19B OUT-OF- POCKET VT = $191M US = $48.7B VT = $168M US = $47.6B *NOTE: This does not include clawback.

15. V e r m o n t Legislative Joint Fiscal Office MEDICAID 2006 United States Medicaid spending decreased by 0.9% First drop in Medicaid spending since program was created in 1965 Exclude Drugs, and Medicaid PHC spending 5.6% –Still slower than 8% in 2005 10 yr avg growth (1996-2006) = 7.1%

16. V e r m o n t Legislative Joint Fiscal Office MEDICAID 2006 Vermont 10 yr avg growth (1996-2006) = 9.6% Medicaid spending increased by 2% –Down from 7% growth in 2005 Drug spending decreased 44% from 2005 –Again exclude Drugs, and Medicaid spending 11%

17. V e r m o n t Legislative Joint Fiscal Office MEDICAID 2006 Vermont (continued) In 2005, Drug spending was 16.9% of Medicaid costs ($146M) In 2006, Drug spending was 8.4% of Medicaid costs ($78.7M) Does not include addl $15.8M state & local spending on drugs

18. V e r m o n t Legislative Joint Fiscal Office PRIVATE HEALTH INSURANCE 2006 U.S. - spending $598.6B to 634.5B –6% increase (2005 to 2006) –7.7% - 10 yr avg annual growth (1996-2006) –36% of personal health care spending VT - spending $1.4 to 1.6B –16% increase (2005 to 2006) –9.1% average annual growth –41% of health care spending

19. V e r m o n t Legislative Joint Fiscal Office Insurance Premiums (2006) From:

20. V e r m o n t Legislative Joint Fiscal Office QUESTIONS?