The report on state-level healthcare spending data for 1991 to 2014 was published online June 14 in Health Affairs. Lead author David Lassman and colleagues said most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in exchange plans -- prompted by the Patient Protection and Affordable Care Act (ACA). Per capita health spending, however, grew at similar rates in both Medicaid expansion and nonexpansion states.
The researchers also found that 2008's economic recession had a persistent effect on health spending and health insurance coverage. Every state experienced slower growth in per capita personal healthcare spending between 2010 and 2013, compared with 2004 to 2009.
"Annual growth in personal healthcare spending by payor varied by state depending on how a state implemented the ACA coverage expansions and the extent to which the recession and recovery affected states differentially," they wrote.
The report showed considerable regional variations in personal healthcare spending: In 2014, the New England and Mideast regions had the highest levels of total per capita personal healthcare spending ($10,119 and $9,370, respectively), while the Rocky Mountain and Southwest regions had the lowest levels ($6,814 and $6,978, respectively), according to the researchers.
Lassman and colleagues also noted the following:
- The state with the highest per enrollee Medicare spending in 2014 was New Jersey, at $12,614; the state with the lowest was Montana, at $8,238.
- Total Medicaid spending increased 12.3% from 2013 to 2014 for states that expanded Medicaid, compared with 6.2% for states that did not.
- Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3% since 2009 ($3,872).
"This study finds that the state-level impacts ... tend to be more evident in underlying spending trends by payor, rather than in aggregated personal healthcare spending trends," they concluded.
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