A blog covering the health/care ecosystem and people.

Today’s financial news reports and the bullish stock market generate headlines saying that the U.S. economy is riding high. President Trump forecasted in late July, “we are now on track to hit an average GDP annual growth of over 3% and it could be substantially over 3%,” Trump said. “Each point, by the way, means approximately $3 trillion and 10 million jobs. Think of that.” Indeed, unemployment is at its lowest rate in decades at 4%. Today, NASDAQ reported that, “the U.S. economy stays strong as the Fed holds steady.” For mainstream working people, though, even with a job in a high employment

  There’s growing evidence that a majority of U.S. voters, across the three-party landscape, agree on two healthcare issues this year: coverage of pre-existing conditions, and lowering the consumer-facing costs of prescription drugs. A new poll jointly conducted by Politico and the Harvard Chan School of Public Health bolsters my read on the latter issue – prescription drug pricing, which has become a mass popular culture union. There may be no other issue on voters’ collective minds for the 2018 mid-term election that so unites American voters than the demand for lower-cost medicines. This is directly relates to consumers’ tri-party

President Trump and his administrative have been trying to make the ACA fail, claim most U.S. adults. Thus, the public holds the POTUS and the Republican party responsible for moving the Affordable Care Act forward….or not, according to the July 2018 Kaiser Health Tracking Poll conducted by the Kaiser Family Foundation (KFF). Health care will be a key issue in the 2018 mid-term elections that will be held in November. Among U.S. voters’ key health care concerns in 2018, one ranks “most” or “very important” for two-thirds of Americans: that is continuing to protect people with pre-existing health conditions. Other issues

America’s agricultural roots go deep, from the native Patuxet tribe that shared maize with Mayflower settling Pilgrims in southern New England, to biodynamic and organic winemakers in Sonoma County, California, operating today. In 2016, 21.4 million full- and part-time jobs were related to agriculture and food sectors, about 11% of total U.S. employment. Farming is an integral part of a nation’s food system, so the Union of Concerned Scientists developed the 50-State Food System Scorecard to gauge the state of farming and food in the U.S. on several dimensions: diet and health outcomes, farming as an industry and economic engine,

The Search for Value is the prevailing journey to a Holy Grail in healthcare these days. On that, most stakeholders working on the ground, globally. can agree. But whose value is it, anyway? Three reports published in the past few weeks give us some useful perspective on that question, woven together in today’s Health Populi blog. Let’s start with the Philips Future Health Index, which assesses value to 16 national health systems through three lenses: access, satisfaction, and efficiency. The results are shown in the map. “Value-based healthcare is contextual, geared towards providing the right care in the right place, at

In the USA, July 4th celebrates the adoption of the Declaration of Independence on that day in 1776. For people with diabetes, July 4th is also an inflection point when blood glucose spikes and kicks off a rise in blood sugar levels through autumn to New Year’s Eve. The team at Livongo observed this by mining 20 million blood glucose measures among its community of people with diabetes. This research debuted in the inaugural Insights Report, Diabetes Across America: Seasons, Regions & More. I appreciated the opportunity to discuss these findings with Dr. Jennifer Schneider, Chief Medical Officer at Livongo. I

          The U.S. gets relatively low ROI for its relatively exorbitant spending on healthcare, noted once again in the latest Health at a Glance, the annual OECD report on member nations’ healthcare systems. The report includes U.S. country data asking, “How does the United States compare?” with its sister OECD countries. The answer is, “not well across most population health, access, and mortality measures.” For the Cliff’s Notes/Where’s Waldo top-line of the research, find the two long bars in this chart heading “south” of the OECD average, and one long blue bar going “north.” The northern climbing bar

The U.S. Department of Commerce Bureau of Economic Analysis (BEA) released, for the first time, data that quantifies Americans’ spending to treat 261 medical conditions, from “A” diseases like acute myocardial infarction, acute renal failure, ADHD, allergic reactions, anxiety disorders, appendicitis and asthma, to dozens of other conditions from the rest of the alphabet. High Spending Growth Rates For Key Diseases In 2000-14 Were Driven By Technology And Demographic Factors, a June 2018 Health Affairs article, analyzed this data. This granular information comes from the BEA’s satellite account, using data from the Medical Expenditure Panel Survey which nationally examines expenditures by disease;

“We are at a remarkable point of cancer treatment,” noted Murray Aitken, Executive Director, IQVIA Institute for Human Data Science, in a call with media this week. 2017 was a banner year of innovative drug launches in oncology, Aitken coined, with more drugs used more extensively, driving improved patient for people dealing with cancer. This upbeat market description comes out of a report on Global Oncology Trends 2018 from the IQVIA Institute for Human Data Science. The subtitle of the report, “Innovation, Expansion and Disruption,” is appropriately put. The report covers these three themes across four sections: advances in therapies,

The rolls of the uninsured are growing in America, the latest Gallup-Sharecare Poll indicates. The U.S. uninsurance rate rose to 12.2% by the fourth quarter of 2017, up 1.3 percentage points from the year before. 2017 reversed advancements in health insurance coverage increases since the advent of the Affordable Care Act, and for the first time since 2014 no states’ uninsured rates fell. The 17 states with declines in insurance rates were Arizona, Colorado, Florida, Hawaii, Illinois, Indiana, Iowa, Missouri, New Mexico, New York, North Carolina, South Carolina, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. Among these, the greatest

When you’re on the battlefield and you can’t see what lies ahead, go high, recommended General Von Clausewitz in his book, On War. I paraphrase this prescription from the good General-strategist’s book, On War — “War is the realm of uncertainty; three-quarters of the factors on which action in war is based are wrapped in a fog of greater or lesser uncertainty. A sensitive and discriminating judgment is called for; a skilled intelligence to scent out the truth.” Governor Mark Leavitt, who held the post of Secretary of Health and Human Services under President Bush, offered this advice at the recent Liberation

Healthcare — availability and affordability — is a more intense worry for Americans in March 2018 than crime and violence, Federal spending, guns, drug use, and hunger and homelessness. The Gallup Poll, fielded in the first week of March 2018, found that peoples’ overall economic and employment concerns are on the decline since 2010, at the height of the Great Recession which began in 2008. While 70% of Americans were worried about economic matters in 2010, only 34% of people in the U.S. were worried about the economy, and 23% about unemployment, in March 2018. Gallup has asked this “worry”

Nearly one-half of Americans experienced a personal data breach in the past three years, the third annual national cybersecurity survey found. Ensuring privacy and cybersecurity should become integrated into the healthcare industry’s consideration of a patient’s consumer experience. This makes sense, given that privacy and cybersecurity ranked the second highest priority to hospitals and healthcare providers polled in HIMSS 2018 Healthcare Leadership Survey. Providers put patient safety as #1. Appropriately, privacy and security were hot topics at HIMSS Annual Conference this year, in respond to providers’ demands for more education and concerns around the challenges. Let’s put these concerns in

“Health agencies will have to become at least as sophisticated as other consumer/retail industries in analyzing a variety of data that helps uncover root causes of human behavior,” Gartner recommended in 2017. That’s because “health” is not all pre-determined by our parent-given genetics. Health is determined by many factors in our own hands, and in forces around us: physical environment, built environment, and public policy. These are the social determinants of health, but knowing them even for the N of 1 patient isn’t quite enough to help the healthcare industry move the needle on outcomes and costs. We need to

In 2020, national health expenditures (NHE) in the United States will exceed $4 trillion to cover 334.5 million Americans. That equates to 18.4% of the Gross Domestic Product (GDP) and $12,230.40 of health spending per person. I sat in on a press call today with researchers from the Office of the Actuary working in the Centers for Medicare and Medicaid Services (CMS) to review the annual forecast of the NHE, published in Health Affairs in a statistically-dense eleven page article titled, National Health Expenditure Projections, 2017-2026: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth. What are those “fundamentals” pushing up healthcare spending?

Let’s change the conversation and put healthcare over  politics.  Sounds just right, doesn’t it? If you’re reading Health Populi, then you’re keen on health policy, health economics, most of all, patients: now playing starring roles as consumers, caregivers, and payors in their own care. Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), has assembled a diverse group of health care leaders who care about those patients/people, too, appropriately named the United States of Care. Founders include Dr. Bill Frist, former Republican U.S. Senator from Tennessee, Dave Durenberger, former Republican U.S. Senator from Minnesota, and

Concerns about health care are, by a large margin, the top domestic policy issue U.S. voters identified as they enter 2018. The proportion of Americans citing healthcare as the top public agenda priority grew by 50% since 2016, from 31% two years ago to 48%. Taxes rank #2 this year, garnering 31% of Americans’ concerned, followed by immigration, which has remained flat cited by about one-in-four Americans. The Associated Press (AP)-NORC Center for Public Affairs Research polled 1,444 U.S. adults 18 and over between November 30 and December 4, 2017 for this survey. While one-half of Americans would like the

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation. Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence. In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

To pay for tax cuts, take money from foreign aid if you must, 1 in 2 Americans say. But do not touch my Medicaid, Medicare, or Social Security, insist the majority of U.S. adults gauged by the November 2017 Kaiser Health Tracking Poll. This month’s survey looks at Americans’ priorities for President Trump and the Congress in light of the GOP tax reforms emerging from Capitol Hill. While reforming taxes is considered a top priority for the President and Congress by 3 in 10 people, two healthcare policy issues are more important to U.S. adults: first, 62% of U.S. adults

The math is straightforward. Assume “A” equals $59.039, the median household income in 2016. Assume “B” is $18,142, the mean employer-sponsored family insurance premium last year. B divided by A equals 30.7%, which is the percent of the average U.S. family’s income represented by the premium cost of health insurance. Compare that to what American households spent on food: just over $7,000, including groceries and eating out (which is garnering a larger share of U.S. eating opportunities, a topic for another post). Thus, health care represents, via the home’s health insurance premium, represents 2.5 times more than food for the

U.S. consumers feel positive about the roles of technology and social determinants in improving healthcare, but are concerned about costs, according to the 2017 Patient Survey Report conducted for The Physicians Foundation. The survey gauged patients’ perspectives across four issues: the physician-patient relationship, the cost of healthcare, social determinants of health, and lifestyle choices. Two key threads in the research explain how Americans feel about healthcare in the U.S. at this moment: the role of technology and the cost of health care. First, the vast majority of consumers view technology, broadly defined, as important for their health care. 85% of people

    The Affordable Care Act (ACT) was implemented in 2010. Since the inception of the ACA, the proportion of uninsured women in the U.S. fell by nearly one-half, from 19 million in 2010 to 11 million in 2016. The Commonwealth Fund has documented the healthcare gains that American women made since the ACA launch in their issue brief, How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care, published earlier this month. The first chart talks about insurance: health care plan coverage, which is the prime raison d’être of the ACA. It’s

  In 2015, poor and low-income people in America had worse health care than high-income households; care for nearly half of the middle-class was also worse than for wealthier families.   Welcome to the 2016 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (AHRQ). The report assesses many measures quantifying peoples’ access to health care, such as uninsurance rates (which improved between 2010 and 2016), and quality of health care — including person-centered care, patient safety, healthy living, effective treatment, care coordination, and care affordability. While some disparities lessened between 2000 and 2015, disparities

On July 23, 1967, I was a little girl wearing a pretty dress, attending my cousin’s wedding at a swanky hotel in mid-town Detroit. Driving home with my parents and sisters after the wedding, the radio news channel warned us of the blazing fires that were burning in a part of the city not far from where we were on a highway leading out to the suburbs. Fifty years and five days later, I am addressing the subject of health equity at a speech over breakfast at the American Hospital Association 25th Annual Health Leadership Summit today. In my talk,

Technology should serve people, and Accenture has identified five major key trends that, together, could forge a person-centered, -friendly, -empowering healthcare system. This is Accenture’s Digital Health Technology Vision for 2017. “Should” and “could” are the important adverbs here, because if tech doesn’t deliver, driving efficiency and effectiveness, personalizing medical treatments, and inspiring people to become more health literate and health-engaging, then tech is just a Field of Dreams being built and available, with no people taking advantage of the potential benefits. The five new-new tech trends are: AI is the new UI, where healthcare experience is everything Ecosystem power

The Netherlands, France and Germany are the best places to be a patient, based on the Global Access to Healthcare Index, developed by the Economist Intelligence Unit (EIU). Throughout the world, nations wrestle with how to provide healthcare to health citizens, in the context of stretched government budgets and demand for innovative and accessible services. The Global Access to Healthcare Index gauges countries’ healthcare systems in light of peoples’ ability to access services, detailed in Global Access to Healthcare: Building Sustainable Health Systems. The United States comes up 10th in line (tied with Spain) in this analysis. Countries that score the

Americans are most worried about healthcare costs among all financial concerns; most people in the U.S. also believe the Federal government should ensure that all people have health coverage. Two polls published in the past week point to the fact that most U.S. health citizens are concerned about health care for themselves and their families, driving a growing proportion of people to favor a single-payer health system. The first line chart illustrates a dramatic trajectory up of the number of American identifying healthcare costs as their #1 financial problem, rising from 10% of people in 2013 to 17% in 2017.

Total prescription drug sales have been trimmed, based on calculations of EvaluatePharma which forecasts a $390 bn drop in revenues between 2017 and 2022. “Political and public scrutiny over pricing of both new and old drugs is not going to go away,” EvaluatePharma called out in its report. The intense scrutiny on pharma industry pricing was fostered by Martin Shkreli in his pricing of Daraprim (taking a $13.50 product raising the price to $750), Harvoni and Sovaldi pricing for Hepatitis C therapies, and last year’s EpiPen pricing uproar. A May 2017 analysis of prescription drug costs by AARP judges that, “Nothing

Only 14% of U.S. adults think that the American Healthcare Act (AHCA) fulfills all or most of President Trump’s campaign promises on health care, according to the May 2017 Kaiser Health Tracking Poll, released today. But political party lines surface when people area asked, overall, “given what you know about this proposed new health care plan, do you have a generally favorite or unfavorable opinion of it?” 55% of U.S. adults have an unfavorable view of the AHCA; however, the split across parties is quite clear: 84% of Democrats have an unfavorable view of the AHCA 57% of Independents ahve

Americans are overwhelmingly keen to use food for their health, and overwhelmed by the amount of nutrition information they face to make good shopping and eating decisions. Welcome to “food confusion,” a phenomenon gleaned from the 12th Annual Food and Health Survey conducted by the International Food Information Council Foundation (IFIC). This 12th annual survey from IFIC finds that most Americans take many steps to be healthy. In the past year, the most popular health-steps include drinking more for hydration, making small changes to achieve a healthier diet, consuming smaller portions, eating more fruits and vegetables, and eating more whole grains.

In accounting, there’s a rule with acronym “LIFO;” this stands for “last in, first out,” which requires taking account of the most recent cost of products being the first ones to be expensed on the ledger. I’m thinking about LIFO when it comes to the American Health Care Act (AHCA) which narrowly passed through Congress yesterday by 4 votes, with a final tally of 217 to 213. Why “LIFO?” Because long-uninsured folks who just recently received access to health insurance as an on-ramp to health care services could lose this benefit, just months after joining the ranks of the insured. Among

“Overall, Council members express pessimism about the health are landscape in the wake of the Trump administration’s proposed plans, citing no clear winners, only losers: patients, clinicians, and provider organizations.” This is the summary of the Leadership Survey report, Anticipating the Trump Administration’s Impact on Health Care, developed by the New England Journal of Medicine‘s NEJM Group. The first chart illustrates the “biggest healthcare losers” finding, detailed on the bottom three bars of patients, clinicians, and provider organizations. The stakeholders that will fare best under a President Trump healthcare agenda would be drug companies, payers, and employers. The biggest loser

As the annual meeting of the American Telemedicine Association convenes this week in Orlando, there’s a lot of telehealth news to curate. The topline of it all: virtual healthcare is mainstreaming, with more providers, payors, and patients aligning in support of virtual health care delivery. Three-quarters of providers have some form of basic telemedicine or telehealth in place. One-third of healthcare providers use some flavor of virtual care technology in their workflow, according to research from KPMG and HIMSS Analytics summarized in the first graphic. KPMG sees virtual care options — remote patient monitoring, enhanced portals, and web interactions for patient-provider

Most US adults favor some kind of national health care plan, based on an Economist/YouGov poll conducted in April 2017. Six in ten people are for expanding so-called “Medicare for All,” where the health plan that currently serves older Americans would extend to all U.S. health citizens. Six in ten people would also favor a Federally-funded health insurance system that would cover all Americans — that is, universal health care. The table details this poll question by political party identification and family income. At least 3 in 4 Democrats would be more likely to favor either of the two healthcare

The statistics on the health of people living in America illustrate a divide between have’s and have-not’s. Average life expectancy is lower in the US compared with other wealthy nations: the wealthiest Americans live 10 to 15 years longer than the poorest, according to a landmark article in JAMA from 2016 studying the relationship between income inequality and mortality. See the first chart: this illustrates that people living in the US whose income reaches the top 95th percentile far outlive folks in the bottom 5th percentile of income. I find myself in London, England, this week, across the Pond (that is,

U.S. consumers love technology, retail, and consumer products; automotive company reputations are improving, even with Volkswagen’s emission scandal potentially tarnishing the industry segment. The only corporate sector whose reputation fell in 2016 was the pharmaceutical industry’s, according to the Harris Poll’s 2017 Reputation Quotient report. The line chart illustrates the decline of pharma’s reputation, which puts it on par with its consumer perceptions in 2010 — just before Medicare Part D was legislated and implemented, which improved pharma’s image among American health citizens (especially older patients who tend to be more frequent consumers of prescription drugs). Pharma’s reputation quotient is back

Most Americans do not believe that TrumpCare, the GOP plan to replace the Affordable Care Act (the ACA, aka  ObamaCare), will make things better for U.S. health citizens when it comes to peoples’ health insurance coverage, the premium costs charged for those health plans, and protections for people with pre-existing medical conditions. The March 2017 Kaiser Family Foundation Health Tracking Poll examined U.S. adults’ initial perceptions of AHCA, the American Health Care Act, which is the GOP’s replacement plan for the ACA. There are deep partisan differences in perceptions about TrumpCare, with more Republicans favorable to the plan — although not

Geography is destiny, Napoleon is thought to have first said. More recently, the brilliant physician Dr. Abraham Verghese has spoken about “geography as destiny” in his speeches, such as “Two Souls Intertwined,” The Tanner Lecture he delivered at the University of Utah in 2012. Geography is destiny for all of us when it comes to our health and well-being, once again proven by Gallup-Healthways in The State of American Well-Being 2016 Community Well-Being Rankings. The darkest blue circles in the U.S. map indicate the metro areas in the highest-quintile of well-being. The index of well-being is based on five metrics, of consumer self-ranking

Price increases and growing use of healthcare services will drive national health spending (NHE) in the U.S. to 20% of the nation’s economy by 2025, according to projections calculated by a team from the Centers for Medicare and Medicaid Services (CMS). Health spending will reach $3.6 trillion dollars this year. These were published in a Web-First article in Health Affairs on 15 February 2017 The caveat on these numbers is that the CMS team used economic models based on “current-law framework:” these make no assumptions about legislative changes that may occur in healthcare reform between 2017 and 2025. While that’s a

The top reason US consumers hear from a debt collector is due to medical bills, for 6 in 10 people in Americans contacted regarding a collection. This month, the Consumer Financial Protection Bureau (CFPB) published its report on Consumer Experiences with Debt Collection. Medical bill collections are the most common debt for which consumers are contacted by collectors, followed by phone bills, utility bills, and tax bills. The prevalence of past-due medical debt is unique compared with these other types because healthcare cost problems impact consumers at low, middle, and high incomes alike. Specifically: 62% of consumers earning $20,000 to

Nurses rank, by far, the top profession for honest and ethics in the U.S. in the 2016 version of the annual Gallup poll on ethics in professions, Americans Rate Healthcare Providers High on Honest, Ethics, published this week. Since 1999, nurses have been #1 in this survey except for the year 2001, when firefighters scored the top spot in light of the 9/11 attack. Another consistency in this survey among U.S. consumers is that pharmacists and physicians top the list once again, after nurses, and the most-trusted professions in America. At the bottom of the roster, as in 2015, are Members

A plurality of Americans, 4 in 10, are dissatisfied with the healthcare costs they face. The level of dissatisfaction varies by a consumer’s type of health insurance, while overall, 42% of people are dissatisfied with costs… 48% of privately insured people are dissatisfied with thei healthcare costs 29% of people on Medicare or Medicaid are dissatisfied 62% of uninsured people are dissatisfied. Gallup has polled Americans on this question since 2014 every November. Dissatisfaction with healthcare costs is up from 38% from the period 2011-2013. As the line chart illustrates, the current levels of cost-dissatisfaction are similar to those felt

People in the U.S. are much more likely to go without health care they need compared with health citizens in 10 other wealthy countries, according to the Commonwealth Fund’s 2016 international survey. One-third of Americans did not seek care due to costs, including going without recommended care, failing to fill a prescription drug, and/or not seeing a doctor when sick. While this self-rationing proportion of Americans dropped from 37% in 2013, the U.S. still ranks #1 in foregoing necessary healthcare due to cost. “In comparison to adults in the other 10 countries, adult sin the U.S. are sicker and more

There is growing support for a single payer healthcare system in America, found in the latest Gallup Poll and a survey the organization conducted earlier this year in May 2016. A slight majority of Americans favor a single payer system, shown in the first chart. By political party, that splits into 3 in 4 Democrats pro-single payer, and 4 in 10 Republicans (41%). Note that the 41% of Republicans who favor single payer is a much higher number than the 16% who favor keeping the Affordable Care Act in place. Gallup writes, “The general idea of a single payer system seems to

While American workers appreciate the benefits they receive at work, people are concerned about health care costs. And consumers’ collective response to rising health care costs is changing the way they use health care services and products, like prescription drugs. Furthermore, 6 in 10 U.S. health citizens rank healthcare as poor (27%) or fair (33%). This sober profile on healthcare consumers emerges out of survey research conducted by EBRI (the Employee Benefit Research Institute), analyzed in the report Workers Like Their Benefits, Are Confident of Future Availability, But Dissatisfied With the Health Care System and Pessimistic About Future Access and

Two in three US voters put the future of the Affordable Care Act as the #1 healthcare issue in the 2016 President election. The ACA is closely followed by healthcare costs — for insurance premiums, deductibles, and prescription drugs, according to the September 2016 Kaiser Health Tracking Poll. The opioid addiction and mortality epidemic is a top healthcare issue for 43% of US voters, and the Zika virus, among 26% of voters. Note that more supporters of Hillary Clinton are healthcare-oriented voters than people who favor Donald Trump. Uninsurance and costs, in addition to the future of the ACA, rank

Federal healthcare program costs are the largest component of mandatory spending in the U.S. budget, according to An Update to the Budget and Economic Outlook: 2016 to 2026 from the U.S. Congressional Budget Office (CBO). Federal spending for healthcare will increase $77 billion in 2016, about 8% over 2015, for a total of $1.1 trillion. The CBO believes that number overstates the growth in Medicare and Medicaid because of a one-time payment shift of $22 bn to Medicare (from 2017 back into 2016); adjusting for this, CBO sees Federal healthcare spending growing 6% (about $55 bn) this year. The driver

Spending on health care in America will comprise $1 in every $5 of gross domestic product in 2025, according to National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected to Shape Spending and Enrollment, featured in the Health Affairs July 2016 issue. Details on national health spending are shown by line item in the table, excerpted from the article. Health spending will grow by 5.8% per year, on average, between 2015 and 2025, based on the calculations by the actuarial team from the Centers for Medicare and Medicaid Services (CMS), authors of the study. The team noted that the Affordable Care