The Medicare Crises: Real or Imagined

1. The Medicare Crises:Real or Imagined Bruce C. Vladeck, Ph.D. Physicians for a National Health Program Boston, MA November 2, 2013

2. Medicare as a Share of the Federal Budget, 2012 Total Federal Spending, FY2012 = $3.5 Trillion Federal Spending on Medicare, FY2012 = $551 Billion NOTE: FY is fiscal year. 1Amount for Medicare excludes offsetting premium receipts (premiums paid by beneficiaries, amount paid to providers and later recovered, and state contribution (clawback) payments to Medicare Part D). 2Other category includes other mandatory outlays, offsetting receipts, and negative outlays for Troubled Asset Relief Program (TARP). SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.

3. Medicare as a share of Federal Budget Outlays, and as a share of Gross Domestic Product (GDP), 1990-2020 Medicare Spending as a Share of Federal Budget Outlays Medicare Spending as a Share of Gross Domestic Product (GDP) SOURCE: CBO Budget and Economic Outlook, January 2011 (for 1990-2010 data) and May 2013 (for 2020 data).

4. Medicare Enrollment, 1970-2035 In millions: Historical Projected SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

5. Projected Change in Medicare Enrollment, 2000-2050 Medicare Enrollment (in millions) Average Annual Growth in Enrollment SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

6. Solvency Projections of the Medicare Part A Trust Fund, 1970-2013 Projected Number of Years to Insolvency and Projected Year of Insolvency: Year of Trustees’ Report NOTES: ‘Insolvency’ refers to the depletion of the trust fund. No insolvency projections were made for 1973-1975 and 1989. For all other years not displayed, the Hospital Insurance Trust Fund was projected to remain solvent for 17 or fewer years. SOURCE: Intermediate projections from 1970-2013 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

7. Median Out-of-Pocket Health Care Spending As a Percent of Income Among Medicare Beneficiaries, 1997-2006 Total health care out-of-pocket Premium out-of-pocket Nonpremiumout-of-pocket NOTES: Differences between 1997 and 2006 are statistically significant for all displayed measures. Annual amounts for the components of total health care spending do not sum to total amounts because values shown are median, not mean, values. SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey Cost and Use files, 1997-2006.

8. Out-of-Pocket Health Spending by Medicare Beneficiaries 65 and Older, by Gender and Type of Service, 2009 $4,844 $4,230 Services NOTE: LTSS are long-term services and supports and include home health spending. Premiums include Medicare Part A, B, C, and D and private health insurance premiums. SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey 2009 Cost and Use file.

9. Income Distribution of Medicare Beneficiaries 65 and Older, by Gender, 2009 Income level: 43% 27% NOTE: Analysis of Medicare beneficiaries 65 and older. SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey 2009 Cost and Use file.

10. Distribution of Medicare Beneficiaries by Income Level, 2012 5%had incomes above $88,900 50% had incomes below $22,500 25% had incomes below $14,000 NOTE: Total household income for couples is split equally between husbands and wives to estimate income for married beneficiaries. SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.

11. Sources of Medicare Revenue, 2012 NOTE: Numbers may not sum due to rounding. Amounts are fiscal year totals. SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.