inflation built into the ACA, such as
readmission penalties for hospitals
and the policy of rewarding doctors
and hospitals for the value of the
services they provide rather than for
the volume. (The rewards come in the
form of higher Medicare and Medicaid
During the next 10 years, though,
aggregate or national health care
spending is expected to rise more than
it did in recent years, when the annual
rate of increase was below 5 percent.
The two big culprits are high-cost
specialty drugs—like those to treat
hepatitis C, which can run upwards
of $100,000 per patient—and, yes, the
bulge in the rolls of the insured under
the ACA. “If you give a whole lot of
people coverage, they are going to use
more care than they did before,” says
Hempstead. “The rule of thumb is
that, as people gain insurance, they use
about 40 percent more care.”
According to a forecast released in
July by the Centers for Medicare and
Medicaid Services, an agency of the U.S.
Department of Health and Human Ser-
vices, national health spending is pro-
jected to increase an average 5. 8 percent
per year from 2014 to 2024. All states,
along with other levels of government,
are expected to finance 47 percent of na-
tional health spending by 2024, up from
43 percent in 2013. Despite this, say
forecasters, the rise in health spending
will still be slower over the next 10 years
than it was during the three decades
prior to the Great Recession, which of-
ficially began in December 2007.
SO HAS OBAMACARE WORKED in New
Jersey? The answer depends on what’s
emphasized. If one considers it a good
thing that many more residents are
insured, and therefore have greater
access to care, then the answer clearly
is yes. If, on the other hand, you are
covered through Obamacare and worried about rising premiums—or if you
get health insurance from another
source and think that increases in state
and national health spending could
eventually raise your taxes—then the
answer is less clear.
Meanwhile, as a result of the state’s
Medicaid expansion, Christie’s fiscal
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