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December 15, 2021 04:02 PM

COVID-19 relief led to nearly 10% jump in 2020 health spending

Maya Goldman
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    U.S. healthcare spending rose 9.7% to $4.1 trillion last year, primarily due to federal COVID-19 relief spending, the actuaries at the Centers for Medicare and Medicaid Services reported Wednesday.

    The jump marks the largest growth in health expenditures since 2002 and spending was more than 5% higher than during 2019. Much of the increase came from federal spending related to the COVID-19 pandemic, such as the Provider Relief Fund and Paycheck Protection Program loans, according to a report the CMS Office of the Actuary published in Health Affairs.

    Health spending constituted 19.7% of gross domestic product. The spike in that share last year is the largest annual increase agency actuaries ever recorded, CMS statistician Micah Hartman said during a news briefing.

    But when spending related to public health and related federal programs is excluded, national health expenditures grew only 1.9%, largely because many people cut back on healthcare utilization during the start of the pandemic.

    Hospital, physician and prescription drug spending all increased. Hospital spending, which amounted to $1.3 trillion and 31% of all healthcare spending, saw similar growth to 2019. Last year, the increase was due entirely to supplemental federal funding related to the pandemic. While out-of-pocket spending on hospital care decreased 12.6%, prices increased 3.2%, compared to 2% in 2019, CMS found.

    Federal healthcare spending increased 36% driving by public health and Medicaid expenditures.
    The Provider Relief Fund made up $121.6 billion of federal health expenses and Paycheck Protection Program loans accounted for $53.3 billion. Nearly $87 billion went to hospitals, with physicians and clinical services and nursing homes receiving an additional $51.5 billion and $20.1 billion, respectively.

    Medicare spending growth slowed from 6.9% in 2019 to 3.5% in 2020. Medicare spending amounted to $829.5 billion, or 20% of national healthcare spending. Medicare enrollment slowed to 2%.

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    The rate of growth in Medicare spending was lower across provider types except nursing homes last year, which the CMS actuaries report was the consequence of public health emergency waivers that removed barriers to nursing home care.

    Medicaid expenditures accounted for 16% of total national health spending at $671.2 billion. The growth rate was roughly three times higher than the previous year's, which the CMS actuaries attribute to more people joining the program. Medicaid enrollment increased by more than 9 million in 2020. Medicaid hospital spending increased 6.7%, partially due to supplemental payments to hospitals and other healthcare facilities.

    Fewer people had employer-sponsored health insurance in 2020, leading to a 1.2% decrease in private payers' share of total health expenditures. Private plan spending decreased by 2.4%.

    Out-of-pocket spending also decreased 3.7%, the first decline since the Great Recession in 2009. Lower utilization and waived cost-sharing requirements for COVID-19 treatment and testing were factors, the actuaries report.

    The uninsured rate declined slightly as 600,000 people gained coverage last year, Hartman said.

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