Table 7. Federal Government Expenditures for Health Services and Supplies: United States, Selected Calendar Years 1987-2000.
- Federal spending for health care reached $237.1 billion in 2000. Medicaid spending consumes the largest portion (51 percent) of Federal health spending, up from 37 percent in 1987. The adjustments to the State and local Medicaid estimates for the disproportionate share hospitals and the upper payment limits schemes do not apply to the Federal estimates of Medicaid. The result is a boost in the implied Federal matching rates and a more rapid increase in the Federal Medicaid spending than would occur in the absence of these schemes.
- Medicare, the second largest component, accounts for 25 percent of Federal health spending. Federal Government Medicare expenditures equal Trust Fund interest income and Federal general revenue contributions to Medicare less the net change in Trust Fund balances (Board of Trustees of the Federal Hospital Insurance Trust Fund, 2001;Board of Trustees of the Federal Supplementary Insurance Trust Fund, 2001).
- The negative growth in Medicare expenditures in 1998 and 1999 was due to the low growth in disbursements for the Medicare program as legislative changes took affect, heightened fraud and abuse measures, and increased household and employer contributions to the Trust Funds resulting from escalating wages. These factors combined to produce significant increases in Medicare HI Trust Fund assets, which (in effect) are lent back to the Federal Government and serve to offset the Federal financing otherwise required for Medicare. The growth in assets in 1998 and 1999 exceeded the growth in interest payments and general fund payments, thereby reducing the net level of Federal Medicare expenditures in those years.
| Federal Spending Category | 1987 | 1993 | 1994 | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 |
|---|---|---|---|---|---|---|---|---|---|
| Amount in Billions | |||||||||
| Federal Government | $75.1 | $175.5 | $184.9 | $196.6 | $213.0 | $218.9 | $214.9 | $223.7 | $237.1 |
| Employer Contribution to Private Health Insurance Premiums | 4.9 | 11.5 | 11.9 | 11.3 | 11.3 | 11.4 | 11.4 | 13.2 | 14.3 |
| Employer Medicare Hospital Insurance Trust Fund Payroll Taxes | 1.7 | 2.3 | 2.3 | 2.3 | 2.4 | 2.4 | 2.4 | 2.5 | 2.6 |
| Medicare1 | 18.1 | 49.6 | 52.8 | 59.3 | 69.3 | 71.4 | 62.3 | 58.8 | 60.0 |
| Health Program Expenditures (Excluding Medicare) | 50.4 | 112.1 | 118.0 | 123.6 | 130.2 | 133.4 | 139.9 | 151.8 | 165.0 |
| Medicaid2 | 28.1 | 78.1 | 83.1 | 88.1 | 94.2 | 97.1 | 101.9 | 110.8 | 120.8 |
| Other Programs3 | 22.3 | 33.9 | 34.9 | 35.5 | 36.0 | 36.3 | 38.0 | 40.9 | 44.2 |
| Percent Distribution | |||||||||
| Share of Federal Spending | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
| Employer Contribution to Private Health Insurance Premiums | 6 | 7 | 6 | 6 | 5 | 5 | 5 | 6 | 6 |
| Employer Medicare Hospital Insurance Trust Fund Payroll Taxes | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Medicare1 | 24 | 28 | 29 | 30 | 33 | 33 | 29 | 26 | 25 |
| Health Program Expenditures (Excluding Medicare) | 67 | 64 | 64 | 63 | 61 | 61 | 65 | 68 | 70 |
| Medicaid2 | 37 | 45 | 45 | 45 | 44 | 44 | 47 | 50 | 51 |
| Other Programs3 | 30 | 19 | 19 | 18 | 17 | 17 | 18 | 18 | 19 |
| Percent Growth from Previous Year Shown | |||||||||
| Growth in Federal Spending | — | 15.2 | 5.4 | 6.3 | 8.3 | 2.8 | -1.8 | 4.1 | 6.0 |
| Employer Contribution to Private Health Insurance Premiums | — | 15.4 | 3.2 | -4.8 | 0.3 | 0.5 | 0.2 | 15.7 | 8.2 |
| Employer Medicare Hospital Insurance Trust Fund Payroll Taxes | — | 4.7 | 1.6 | 1.3 | 1.4 | 1.2 | 1.3 | 3.5 | 5.5 |
| Medicare1 | — | 18.3 | 6.3 | 12.4 | 16.7 | 3.0 | -12.7 | -5.5 | 2.0 |
| Health Program Expenditures (Excluding Medicare) | — | 14.2 | 5.3 | 4.8 | 5.3 | 2.5 | 4.9 | 8.5 | 8.7 |
| Medicaid2 | — | 18.6 | 6.3 | 6.1 | 6.9 | 3.1 | 4.9 | 8.8 | 9.0 |
| Other Programs3 | — | 7.2 | 2.9 | 1.8 | 1.3 | 0.9 | 4.8 | 7.6 | 8.0 |
1
Excludes Medicare Hospital Trust Fund payroll taxes and premiums, Medicare supplementary medical insurance premiums, and Medicaid premium payments.
2
Includes Medicaid buy-in premiums for Medicare.
3
Includes maternal and child health, vocational rehabilitation, Substance Abuse and Mental Health Services Administration, Indian Health Service, Federal workers' compensation, and other miscellaneous general hospital and medical programs, public health activities, Department of Defense, Department of Veterans Affairs, and State Children's Health Insurance Program.
NOTE: Columns may not add to figures shown because of rounding.
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary: Data from the National Health Statistics Group.