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Hospital Prices Have Risen Much Faster for Private Insurance Than Medicare Since 2019

Hospitals account for nearly one-third of US health spending and 40% of spending growth from 2022-2024. Analysis shows hospital prices paid by private insurers have risen faster than Medicare rates since 2019, a trend with implications for affordability.

Hospital prices paid by private insurers rose 30% from 2019-2026, compared to a 21% increase in Medicare payment rates. The disparate growth widened an existing gap between what Medicare and private plans pay for hospital services.

What Are the Recent Trends in Employer-Based Health Coverage?

Policy Changes Bring Renewed Focus on High-Deductible Health Plans

Health Insurer Financial Performance in 2024

Examining Short-Term Limited-Duration Health Plans

Health Care Affordability

BTD Health Policy in 2026

Health Policy in 2026

President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”

View all of Drew’s Beyond the Data Columns

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  • Data Note: Effect of State Decisions on State Risk Scores

    Issue Brief

    To gauge whether individual market risk pools are healthier in states that have expanded Medicaid and did not allow transitional plans, this data note compares average state risk scores using data from the Centers for Medicare & Medicaid Services Summary Report on Risk Adjustment for the 2015 benefit year. The analysis finds that states that expanded Medicaid and did not allow transitional plans had lower average risk scores, suggesting the risk pools in those state’s…

  • Data Note: How Has the Individual Insurance Market Grown Under the Affordable Care Act?

    Issue Brief

    This data note examines changes in the individual insurance market under the Affordable Care Act. Through analysis of filings by insurers to state insurance departments, the Kaiser Family Foundation estimates that the number of people enrolled in the individual insurance market grew 40 percent from the end-of-year 2013 to the end-of-year 2014 and has likely continued growing in 2015 as well.

  • ACA Mandate Repeal May Be Less Popular Than GOP Thinks

    From Drew Altman

    In this Axios column, Drew Altman discusses how public opinion seems to flip on eliminating the individual mandate as part of the tax legislation, from for it to against, when the public considers the consequences.

  • Why are Healthcare Prices So High, and What can be Done about Them?

    Event Date:
    Event

    An archived webcast of this forum is now available at www.healthsystemtracker.org . Nearly a fifth of the United States’ economy goes to healthcare spending – a far larger share than in any other large, wealthy country in the world. Research suggests that price, rather than the volume of services, is the main driver of this disparity, and price is also a primary factor in pushing up the nation’s health spending over time. On May 9, 2018,…

  • Analysis: Individual Market Insurers Experienced Their Best Financial Year under the ACA in 2017, Though Subsequent Political and Policy Changes Complicate the Outlook for Future Years

    News Release

    Insurers in 2017 had their best financial year selling individual market health insurance since the Affordable Care Act began requiring guaranteed access to coverage for people with pre-existing conditions in 2014, though recent political and policy changes create new challenges for insurers trying to succeed in this market, new Kaiser Family Foundation analysis finds. This analysis finds insurers posted their strongest performance in the individual market using two different financial indicators: The average share of…

  • Explaining Health Care Reform: Medical Loss Ratio (MLR)

    Fact Sheet

    This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and…

  • Employer Responsibility Under the Affordable Care Act

    Other Post

    The Affordable Care Act does not require businesses to provide health benefits to their workers, but applicable large employers may face penalties if they don’t make affordable coverage available. The employer shared responsibility provision of the Affordable Care Act penalizes employers who either do not offer coverage or do not offer coverage that meets minimum value and affordability standards. These penalties apply to firms with 50 or more full-time equivalent employees. This flowchart illustrates how…

  • The Cost of the Individual Mandate Penalty for the Remaining Uninsured

    Issue Brief

    This analysis provides estimates of the share of uninsured people eligible to enroll in the Affordable Care Act marketplaces who will be subject to the individual mandate penalty, and how those penalties are increasing for 2016. It also provides estimates of the number of people who could have a zero-dollar contribution or pay less for health insurance than the penalty, due to premium subsidies, and the number of people who would pay more for a…