Alicia Ault

WASHINGTON — Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year. The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings (Health Affairs 2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, said Anne Martin, an economist at the CMS Office of the Actuary.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician. Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services.

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years.

WASHINGTON — Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year. The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings (Health Affairs 2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, said Anne Martin, an economist at the CMS Office of the Actuary.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician. Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services.

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years.

WASHINGTON — Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year. The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings (Health Affairs 2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, said Anne Martin, an economist at the CMS Office of the Actuary.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician. Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services.

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years.

The Food and Drug Administration has approved the monoclonal antibody denosumab (Xgeva), which is indicated for fracture prevention in postmenopausal women at high risk, for the prevention of skeletal-related events in patients with bone metastases from solid tumors.

Denosumab maker Amgen made the announcement. The drug was given a 6-month priority review, indicating that it was considered a major advance in treatment.

“Xgeva has a different mechanism of action than currently approved drugs aimed at reducing bone complications from cancer,” Dr. Richard Pazdur, director of the Office of Oncology Drug Products in the FDA's Center for Drug Evaluation and Research, said in a written statement on the approval for the new indication.

A fully human monoclonal antibody with a unique mechanism of action, denosumab specifically targets the receptor activator of the nuclear factor kappa-B (RANK) ligand, the essential mediator of osteoclast fusion. The drug inhibits osteoclast formation, function, and survival, resulting in reduced bone resorption. The RANK ligand pathway was discovered by Amgen scientists in the mid-1990s, according to the company.

Amgen reported that bone metastases occur in 1.5 million cancer patients worldwide. They are most commonly seen in prostate, lung, and breast cancer. Denosumab was not approved for bone metastases related to multiple myeloma.

“A diagnosis of bone metastases is a major event for patients living with cancer, and the consequences can be devastating,” Amgen chairman and CEO Kevin Sharer wrote in a statement. “We are pleased to offer this new advance to patients and their health care providers.”

The approval of denosumab was based on three phase III head-to-head trials comprising 5,700 patients that compared the drug with zoledronic acid (Zometa).

The drug was superior to zoledronic acid in preventing skeletal-related events (SRE) in breast and prostate cancer. Some of those data were presented in June at the annual meeting of the American Society of Clinical Oncology. Denosumab was noninferior in preventing SREs in multiple myeloma and other solid tumors.

Adverse effects include hypocalcemia, fatigue, hypophosphatemia, and nausea. Osteonecrosis of the jaw can also occur.

Xgeva is delivered every 4 weeks as a 120-mg subcutaneous injection.

Because of the drug's expense, Amgen is launching a new patient assistance program. The Xgeva First Step Coupon Program will provide assistance to eligible patients who need help meeting a deductible, copayment, or coinsurance. The first injection would be covered and subsequent injections would cost a maximum of $25.

The Food and Drug Administration has approved the monoclonal antibody denosumab (Xgeva), which is indicated for fracture prevention in postmenopausal women at high risk, for the prevention of skeletal-related events in patients with bone metastases from solid tumors.

Denosumab maker Amgen made the announcement. The drug was given a 6-month priority review, indicating that it was considered a major advance in treatment.

“Xgeva has a different mechanism of action than currently approved drugs aimed at reducing bone complications from cancer,” Dr. Richard Pazdur, director of the Office of Oncology Drug Products in the FDA's Center for Drug Evaluation and Research, said in a written statement on the approval for the new indication.

A fully human monoclonal antibody with a unique mechanism of action, denosumab specifically targets the receptor activator of the nuclear factor kappa-B (RANK) ligand, the essential mediator of osteoclast fusion. The drug inhibits osteoclast formation, function, and survival, resulting in reduced bone resorption. The RANK ligand pathway was discovered by Amgen scientists in the mid-1990s, according to the company.

Amgen reported that bone metastases occur in 1.5 million cancer patients worldwide. They are most commonly seen in prostate, lung, and breast cancer. Denosumab was not approved for bone metastases related to multiple myeloma.

“A diagnosis of bone metastases is a major event for patients living with cancer, and the consequences can be devastating,” Amgen chairman and CEO Kevin Sharer wrote in a statement. “We are pleased to offer this new advance to patients and their health care providers.”

The approval of denosumab was based on three phase III head-to-head trials comprising 5,700 patients that compared the drug with zoledronic acid (Zometa).

The drug was superior to zoledronic acid in preventing skeletal-related events (SRE) in breast and prostate cancer. Some of those data were presented in June at the annual meeting of the American Society of Clinical Oncology. Denosumab was noninferior in preventing SREs in multiple myeloma and other solid tumors.

Adverse effects include hypocalcemia, fatigue, hypophosphatemia, and nausea. Osteonecrosis of the jaw can also occur.

Xgeva is delivered every 4 weeks as a 120-mg subcutaneous injection.

Because of the drug's expense, Amgen is launching a new patient assistance program. The Xgeva First Step Coupon Program will provide assistance to eligible patients who need help meeting a deductible, copayment, or coinsurance. The first injection would be covered and subsequent injections would cost a maximum of $25.

The Food and Drug Administration has approved the monoclonal antibody denosumab (Xgeva), which is indicated for fracture prevention in postmenopausal women at high risk, for the prevention of skeletal-related events in patients with bone metastases from solid tumors.

Denosumab maker Amgen made the announcement. The drug was given a 6-month priority review, indicating that it was considered a major advance in treatment.

“Xgeva has a different mechanism of action than currently approved drugs aimed at reducing bone complications from cancer,” Dr. Richard Pazdur, director of the Office of Oncology Drug Products in the FDA's Center for Drug Evaluation and Research, said in a written statement on the approval for the new indication.

A fully human monoclonal antibody with a unique mechanism of action, denosumab specifically targets the receptor activator of the nuclear factor kappa-B (RANK) ligand, the essential mediator of osteoclast fusion. The drug inhibits osteoclast formation, function, and survival, resulting in reduced bone resorption. The RANK ligand pathway was discovered by Amgen scientists in the mid-1990s, according to the company.

Amgen reported that bone metastases occur in 1.5 million cancer patients worldwide. They are most commonly seen in prostate, lung, and breast cancer. Denosumab was not approved for bone metastases related to multiple myeloma.

“A diagnosis of bone metastases is a major event for patients living with cancer, and the consequences can be devastating,” Amgen chairman and CEO Kevin Sharer wrote in a statement. “We are pleased to offer this new advance to patients and their health care providers.”

The approval of denosumab was based on three phase III head-to-head trials comprising 5,700 patients that compared the drug with zoledronic acid (Zometa).

The drug was superior to zoledronic acid in preventing skeletal-related events (SRE) in breast and prostate cancer. Some of those data were presented in June at the annual meeting of the American Society of Clinical Oncology. Denosumab was noninferior in preventing SREs in multiple myeloma and other solid tumors.

Adverse effects include hypocalcemia, fatigue, hypophosphatemia, and nausea. Osteonecrosis of the jaw can also occur.

Xgeva is delivered every 4 weeks as a 120-mg subcutaneous injection.

Because of the drug's expense, Amgen is launching a new patient assistance program. The Xgeva First Step Coupon Program will provide assistance to eligible patients who need help meeting a deductible, copayment, or coinsurance. The first injection would be covered and subsequent injections would cost a maximum of $25.

Beginning this year, health insurance companies will be required to prove that they spend at least 80% of premium dollars collected on direct medical care and quality improvement efforts under new federal regulations.

The interim final rule took effect Jan. 1 and was required by the Affordable Care Act. The so-called medical loss ratio rule was developed by the National Association of Insurance Commissioners, which submitted its recommendations to the Health and Human Services department in late October.

According to the rule, HHS will review insurers' medical loss data at the end of 2010. Companies that spend less than 80%-85% of their premium dollar on direct medical care will be required to issue rebates to consumers, said HHS Secretary Kathleen Sebelius at a press briefing. The rebate checks will begin arriving in 2012.

In some markets, insurers spend as little as 60% of the premium dollar on direct care, said Ms. Sebelius, who added that under the rule, those companies might have “to return nearly $3,500 to every family they insure.” Her calculation was based on an average annual premium of $13,250 paid by a family of four.

Ms. Sebelius and other HHS officials said the rule was an important new consumer law. An estimated 74.8 million Americans will be protected by the new medical loss ratio requirements, and up to 9 million Americans could be eligible for rebates in the first year, according to HHS.

Timothy Jost, a professor of law at Washington and Lee University, Lexington, Va., who advised the NAIC task force, said he estimated that insurers currently spend 12% of the premium dollar on pharmaceuticals and 31% for physician services, and 31% on administrative costs. The rule “will drive insurers to become more efficient,” and “incentivize them to not raise premiums more than necessary,” he said during the briefing.

Perhaps in response to opponents who have complained that the passage of the ACA was a closed-door process, HHS and NAIC officials at the briefing said that the medical loss ratio rule had been developed in a very public fashion, with open hearings.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the states, and other key stakeholders” said Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight.

Jane Cline, president of the NAIC and insurance commissioner for West Virginia, said there were safeguards in the rule to ensure that it would not destabilize the insurance markets. The HHS Secretary will have the ability to adjust the medical loss ratio on a state-by-state basis to ensure that there is access to insurance.

Four states – Georgia, Iowa, Maine, and South Carolina – have already asked HHS to change the requirements for insurers operating there; others could follow suit, Mr. Angoff said.

Transparency will be required of insurers as well. Starting in 2011 they will have to report publicly how they spend their premium dollars.

Beginning this year, health insurance companies will be required to prove that they spend at least 80% of premium dollars collected on direct medical care and quality improvement efforts under new federal regulations.

The interim final rule took effect Jan. 1 and was required by the Affordable Care Act. The so-called medical loss ratio rule was developed by the National Association of Insurance Commissioners, which submitted its recommendations to the Health and Human Services department in late October.

According to the rule, HHS will review insurers' medical loss data at the end of 2010. Companies that spend less than 80%-85% of their premium dollar on direct medical care will be required to issue rebates to consumers, said HHS Secretary Kathleen Sebelius at a press briefing. The rebate checks will begin arriving in 2012.

In some markets, insurers spend as little as 60% of the premium dollar on direct care, said Ms. Sebelius, who added that under the rule, those companies might have “to return nearly $3,500 to every family they insure.” Her calculation was based on an average annual premium of $13,250 paid by a family of four.

Ms. Sebelius and other HHS officials said the rule was an important new consumer law. An estimated 74.8 million Americans will be protected by the new medical loss ratio requirements, and up to 9 million Americans could be eligible for rebates in the first year, according to HHS.

Timothy Jost, a professor of law at Washington and Lee University, Lexington, Va., who advised the NAIC task force, said he estimated that insurers currently spend 12% of the premium dollar on pharmaceuticals and 31% for physician services, and 31% on administrative costs. The rule “will drive insurers to become more efficient,” and “incentivize them to not raise premiums more than necessary,” he said during the briefing.

Perhaps in response to opponents who have complained that the passage of the ACA was a closed-door process, HHS and NAIC officials at the briefing said that the medical loss ratio rule had been developed in a very public fashion, with open hearings.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the states, and other key stakeholders” said Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight.

Jane Cline, president of the NAIC and insurance commissioner for West Virginia, said there were safeguards in the rule to ensure that it would not destabilize the insurance markets. The HHS Secretary will have the ability to adjust the medical loss ratio on a state-by-state basis to ensure that there is access to insurance.

Four states – Georgia, Iowa, Maine, and South Carolina – have already asked HHS to change the requirements for insurers operating there; others could follow suit, Mr. Angoff said.

Transparency will be required of insurers as well. Starting in 2011 they will have to report publicly how they spend their premium dollars.

Beginning this year, health insurance companies will be required to prove that they spend at least 80% of premium dollars collected on direct medical care and quality improvement efforts under new federal regulations.

The interim final rule took effect Jan. 1 and was required by the Affordable Care Act. The so-called medical loss ratio rule was developed by the National Association of Insurance Commissioners, which submitted its recommendations to the Health and Human Services department in late October.

According to the rule, HHS will review insurers' medical loss data at the end of 2010. Companies that spend less than 80%-85% of their premium dollar on direct medical care will be required to issue rebates to consumers, said HHS Secretary Kathleen Sebelius at a press briefing. The rebate checks will begin arriving in 2012.

In some markets, insurers spend as little as 60% of the premium dollar on direct care, said Ms. Sebelius, who added that under the rule, those companies might have “to return nearly $3,500 to every family they insure.” Her calculation was based on an average annual premium of $13,250 paid by a family of four.

Ms. Sebelius and other HHS officials said the rule was an important new consumer law. An estimated 74.8 million Americans will be protected by the new medical loss ratio requirements, and up to 9 million Americans could be eligible for rebates in the first year, according to HHS.

Timothy Jost, a professor of law at Washington and Lee University, Lexington, Va., who advised the NAIC task force, said he estimated that insurers currently spend 12% of the premium dollar on pharmaceuticals and 31% for physician services, and 31% on administrative costs. The rule “will drive insurers to become more efficient,” and “incentivize them to not raise premiums more than necessary,” he said during the briefing.

Perhaps in response to opponents who have complained that the passage of the ACA was a closed-door process, HHS and NAIC officials at the briefing said that the medical loss ratio rule had been developed in a very public fashion, with open hearings.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the states, and other key stakeholders” said Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight.

Jane Cline, president of the NAIC and insurance commissioner for West Virginia, said there were safeguards in the rule to ensure that it would not destabilize the insurance markets. The HHS Secretary will have the ability to adjust the medical loss ratio on a state-by-state basis to ensure that there is access to insurance.

Four states – Georgia, Iowa, Maine, and South Carolina – have already asked HHS to change the requirements for insurers operating there; others could follow suit, Mr. Angoff said.

Transparency will be required of insurers as well. Starting in 2011 they will have to report publicly how they spend their premium dollars.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is “consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs.”

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is “consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs.”

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is “consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs.”

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

Surgeon Heads House Panel

Dr. Charles Boustany Jr., a Republican House member from Louisiana and a former cardiothoracic surgeon, has been named to head the Ways and Means Oversight and Investigations Subcommittee. In a statement after his appointment, Rep. Boustany made no secret of his desire to take on the Affordable Care Act through his subcommittee. “As we begin to undo the damage caused by President Obama's health-care law, I plan to hold [Internal Revenue Service] officials accountable to the taxpayers and press them on how this law will be implemented,” he said. “I also plan to work with the Government Accountability Office and other watchdog groups to identify existing programs … that warrant review and improvements to save taxpayer dollars and increase efficiency,” he said. Social Security, Medicare, and Medicaid are among the programs that are within the Ways and Means Committee's jurisdiction. Meanwhile, Rep. Wally Herger (R-Calif.) was appointed chairman of the Ways and Means Health Subcommittee. He told the Congressional Quarterly that he too will focus on repealing health care reform, as well as bringing down medical costs.

Company Offers Freebie Advice

The Advanced Medical Technology Association (AdvaMed) has issued new guidance to its member companies on business meals, educational support, gift items of benefit to patients, and appropriate support of conferences. The advice focuses on certain sections of the association's Code on Ethical Interactions with Health Care Professionals, last revised in 2009. “The guidance issued by AdvaMed today provides an easy to digest set of practices to help industry follow the AdvaMed code and is the first in what we anticipate to be continued quarterly guidance on industry best practices,” said Jeffrey R. Binder, chairman of the AdvaMed ethics committee and CEO of Biomet, in a statement.

Coding Gets New Rhythm Section

The Centers for Medicare and Medicaid Services has developed a new specialty code that the Heart Rhythm Society had advocated for electrophysiology, allowing the CMS to distinguish between an electrophysiologist's and a cardiologist's billing of Medicare. Effective April 1, the new physician specialty code number 21 “will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient, and will enhance our efforts to improve the quality of care for people living with heart rhythm disorders,” said Dr. Douglas L. Packer, president of the Heart Rhythm Society, in a statement.

Women's Care Graded 'U'

The United States has once again deserved an overall grade of “unsatisfactory” in meeting women's health needs, according to a new report card from the National Women's Law Center. The report, which is the fifth produced by the group, graded the nation “satisfactory” on only three indicators of women's health: those aged 40 and older receiving regular mammograms, annual visits to the dentist, and women aged 50 and older getting colorectal cancer screening. But the United States received a failing grade on 13 of 26 indicators. The nation improved on only one indicator, rising from “unsatisfactory” to “satisfactory minus” in cholesterol screening for women.

Life Expectancy Declines a Bit

Overall life expectancy in the United States declined by about 1 month from 2007 to 2008, but it will take more years to determine whether that decline represents a trend, according to the National Center for Health Statistics. Life expectancy at birth fell from 77.9 years in 2007 to 77.8 years in 2008 for both men and women. However, black men gained a record-high life expectancy of 70.2 years in 2008, which was up from 70.0 years in 2007, and the gap between white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007, the agency said. Heart disease and cancer, the two leading causes of death, accounted for 48% of all deaths during 2008. Stroke fell from the third-leading cause of death to the fourth, whereas chronic lower respiratory diseases took their place as number three on the list, the NCHS said. However, that shift may be the result of a modification in how deaths from chronic lower respiratory diseases are classified, the agency said.

Report: Send Technology Home

One solution to two major challenges facing health care systems worldwide could be the expansion of home health care technology, according to a report by the Rand Corp. “The aging of the world's population and [the] fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems,” Dr. Soeren Mattke, lead author and a senior scientist at Rand, said in a statement. It is possible to move technologies ranging from glucose meters to advanced telemedicine devices into homes, “where patients or family members can manage care,” said Dr. Mattke. He and his coauthors admitted in their report that barriers exist, such as insurance coverage, patients' readiness, and their compliance. The authors arrived at their findings after interviewing providers, officials, insurers, and patient groups in China, France, Germany, Singapore, the United Kingdom, and the United States.

Surgeon Heads House Panel

Dr. Charles Boustany Jr., a Republican House member from Louisiana and a former cardiothoracic surgeon, has been named to head the Ways and Means Oversight and Investigations Subcommittee. In a statement after his appointment, Rep. Boustany made no secret of his desire to take on the Affordable Care Act through his subcommittee. “As we begin to undo the damage caused by President Obama's health-care law, I plan to hold [Internal Revenue Service] officials accountable to the taxpayers and press them on how this law will be implemented,” he said. “I also plan to work with the Government Accountability Office and other watchdog groups to identify existing programs … that warrant review and improvements to save taxpayer dollars and increase efficiency,” he said. Social Security, Medicare, and Medicaid are among the programs that are within the Ways and Means Committee's jurisdiction. Meanwhile, Rep. Wally Herger (R-Calif.) was appointed chairman of the Ways and Means Health Subcommittee. He told the Congressional Quarterly that he too will focus on repealing health care reform, as well as bringing down medical costs.

Company Offers Freebie Advice

The Advanced Medical Technology Association (AdvaMed) has issued new guidance to its member companies on business meals, educational support, gift items of benefit to patients, and appropriate support of conferences. The advice focuses on certain sections of the association's Code on Ethical Interactions with Health Care Professionals, last revised in 2009. “The guidance issued by AdvaMed today provides an easy to digest set of practices to help industry follow the AdvaMed code and is the first in what we anticipate to be continued quarterly guidance on industry best practices,” said Jeffrey R. Binder, chairman of the AdvaMed ethics committee and CEO of Biomet, in a statement.

Coding Gets New Rhythm Section

The Centers for Medicare and Medicaid Services has developed a new specialty code that the Heart Rhythm Society had advocated for electrophysiology, allowing the CMS to distinguish between an electrophysiologist's and a cardiologist's billing of Medicare. Effective April 1, the new physician specialty code number 21 “will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient, and will enhance our efforts to improve the quality of care for people living with heart rhythm disorders,” said Dr. Douglas L. Packer, president of the Heart Rhythm Society, in a statement.

Women's Care Graded 'U'

The United States has once again deserved an overall grade of “unsatisfactory” in meeting women's health needs, according to a new report card from the National Women's Law Center. The report, which is the fifth produced by the group, graded the nation “satisfactory” on only three indicators of women's health: those aged 40 and older receiving regular mammograms, annual visits to the dentist, and women aged 50 and older getting colorectal cancer screening. But the United States received a failing grade on 13 of 26 indicators. The nation improved on only one indicator, rising from “unsatisfactory” to “satisfactory minus” in cholesterol screening for women.

Life Expectancy Declines a Bit

Overall life expectancy in the United States declined by about 1 month from 2007 to 2008, but it will take more years to determine whether that decline represents a trend, according to the National Center for Health Statistics. Life expectancy at birth fell from 77.9 years in 2007 to 77.8 years in 2008 for both men and women. However, black men gained a record-high life expectancy of 70.2 years in 2008, which was up from 70.0 years in 2007, and the gap between white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007, the agency said. Heart disease and cancer, the two leading causes of death, accounted for 48% of all deaths during 2008. Stroke fell from the third-leading cause of death to the fourth, whereas chronic lower respiratory diseases took their place as number three on the list, the NCHS said. However, that shift may be the result of a modification in how deaths from chronic lower respiratory diseases are classified, the agency said.

Report: Send Technology Home

One solution to two major challenges facing health care systems worldwide could be the expansion of home health care technology, according to a report by the Rand Corp. “The aging of the world's population and [the] fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems,” Dr. Soeren Mattke, lead author and a senior scientist at Rand, said in a statement. It is possible to move technologies ranging from glucose meters to advanced telemedicine devices into homes, “where patients or family members can manage care,” said Dr. Mattke. He and his coauthors admitted in their report that barriers exist, such as insurance coverage, patients' readiness, and their compliance. The authors arrived at their findings after interviewing providers, officials, insurers, and patient groups in China, France, Germany, Singapore, the United Kingdom, and the United States.

Surgeon Heads House Panel

Dr. Charles Boustany Jr., a Republican House member from Louisiana and a former cardiothoracic surgeon, has been named to head the Ways and Means Oversight and Investigations Subcommittee. In a statement after his appointment, Rep. Boustany made no secret of his desire to take on the Affordable Care Act through his subcommittee. “As we begin to undo the damage caused by President Obama's health-care law, I plan to hold [Internal Revenue Service] officials accountable to the taxpayers and press them on how this law will be implemented,” he said. “I also plan to work with the Government Accountability Office and other watchdog groups to identify existing programs … that warrant review and improvements to save taxpayer dollars and increase efficiency,” he said. Social Security, Medicare, and Medicaid are among the programs that are within the Ways and Means Committee's jurisdiction. Meanwhile, Rep. Wally Herger (R-Calif.) was appointed chairman of the Ways and Means Health Subcommittee. He told the Congressional Quarterly that he too will focus on repealing health care reform, as well as bringing down medical costs.

Company Offers Freebie Advice

The Advanced Medical Technology Association (AdvaMed) has issued new guidance to its member companies on business meals, educational support, gift items of benefit to patients, and appropriate support of conferences. The advice focuses on certain sections of the association's Code on Ethical Interactions with Health Care Professionals, last revised in 2009. “The guidance issued by AdvaMed today provides an easy to digest set of practices to help industry follow the AdvaMed code and is the first in what we anticipate to be continued quarterly guidance on industry best practices,” said Jeffrey R. Binder, chairman of the AdvaMed ethics committee and CEO of Biomet, in a statement.

Coding Gets New Rhythm Section

The Centers for Medicare and Medicaid Services has developed a new specialty code that the Heart Rhythm Society had advocated for electrophysiology, allowing the CMS to distinguish between an electrophysiologist's and a cardiologist's billing of Medicare. Effective April 1, the new physician specialty code number 21 “will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient, and will enhance our efforts to improve the quality of care for people living with heart rhythm disorders,” said Dr. Douglas L. Packer, president of the Heart Rhythm Society, in a statement.

Women's Care Graded 'U'

The United States has once again deserved an overall grade of “unsatisfactory” in meeting women's health needs, according to a new report card from the National Women's Law Center. The report, which is the fifth produced by the group, graded the nation “satisfactory” on only three indicators of women's health: those aged 40 and older receiving regular mammograms, annual visits to the dentist, and women aged 50 and older getting colorectal cancer screening. But the United States received a failing grade on 13 of 26 indicators. The nation improved on only one indicator, rising from “unsatisfactory” to “satisfactory minus” in cholesterol screening for women.

Life Expectancy Declines a Bit

Overall life expectancy in the United States declined by about 1 month from 2007 to 2008, but it will take more years to determine whether that decline represents a trend, according to the National Center for Health Statistics. Life expectancy at birth fell from 77.9 years in 2007 to 77.8 years in 2008 for both men and women. However, black men gained a record-high life expectancy of 70.2 years in 2008, which was up from 70.0 years in 2007, and the gap between white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007, the agency said. Heart disease and cancer, the two leading causes of death, accounted for 48% of all deaths during 2008. Stroke fell from the third-leading cause of death to the fourth, whereas chronic lower respiratory diseases took their place as number three on the list, the NCHS said. However, that shift may be the result of a modification in how deaths from chronic lower respiratory diseases are classified, the agency said.

Report: Send Technology Home

One solution to two major challenges facing health care systems worldwide could be the expansion of home health care technology, according to a report by the Rand Corp. “The aging of the world's population and [the] fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems,” Dr. Soeren Mattke, lead author and a senior scientist at Rand, said in a statement. It is possible to move technologies ranging from glucose meters to advanced telemedicine devices into homes, “where patients or family members can manage care,” said Dr. Mattke. He and his coauthors admitted in their report that barriers exist, such as insurance coverage, patients' readiness, and their compliance. The authors arrived at their findings after interviewing providers, officials, insurers, and patient groups in China, France, Germany, Singapore, the United Kingdom, and the United States.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year (Health Affairs 2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large decline in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans seeing the doctor. Data show that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, the report said. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is “consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity.”

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year (Health Affairs 2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large decline in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans seeing the doctor. Data show that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, the report said. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is “consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity.”

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation's total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation's gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year (Health Affairs 2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation's health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large decline in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation's health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid's spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans seeing the doctor. Data show that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they'd skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, the report said. Spending for “clinical services,” which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is “consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity.”

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs (2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs (2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services (CMS).

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs (2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law's requirement that individuals purchase health insurance and also the ACA's requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress' regulatory powers.

"The individual mandate falls outside the boundary of Congress' Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be 'proper.' "

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If ... the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff's argument that the mandate exceeded Congress' authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson's decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge's decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don't."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson's decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America's families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law's requirement that individuals purchase health insurance and also the ACA's requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress' regulatory powers.

"The individual mandate falls outside the boundary of Congress' Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be 'proper.' "

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If ... the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff's argument that the mandate exceeded Congress' authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson's decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge's decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don't."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson's decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America's families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law's requirement that individuals purchase health insurance and also the ACA's requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress' regulatory powers.

"The individual mandate falls outside the boundary of Congress' Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be 'proper.' "

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If ... the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff's argument that the mandate exceeded Congress' authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson's decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge's decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don't."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson's decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America's families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law’s requirement that individuals purchase health insurance and also the ACA’s requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision (pdf), Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress’ regulatory powers.

"The individual mandate falls outside the boundary of Congress’ Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be ‘proper’."

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If...the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff’s argument that the mandate exceeded Congress’ authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson’s decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don’t."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson’s decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America’s families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law’s requirement that individuals purchase health insurance and also the ACA’s requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision (pdf), Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress’ regulatory powers.

"The individual mandate falls outside the boundary of Congress’ Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be ‘proper’."

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If...the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff’s argument that the mandate exceeded Congress’ authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson’s decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don’t."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson’s decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America’s families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law’s requirement that individuals purchase health insurance and also the ACA’s requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision (pdf), Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress’ regulatory powers.

"The individual mandate falls outside the boundary of Congress’ Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be ‘proper’."

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If...the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff’s argument that the mandate exceeded Congress’ authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson’s decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don’t."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson’s decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America’s families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law’s requirement that individuals purchase health insurance and also the ACA’s requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision (pdf), Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress’ regulatory powers.

"The individual mandate falls outside the boundary of Congress’ Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be ‘proper’."

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If...the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff’s argument that the mandate exceeded Congress’ authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson’s decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don’t."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson’s decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America’s families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law’s requirement that individuals purchase health insurance and also the ACA’s requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision (pdf), Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress’ regulatory powers.

"The individual mandate falls outside the boundary of Congress’ Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be ‘proper’."

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If...the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff’s argument that the mandate exceeded Congress’ authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson’s decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don’t."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson’s decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America’s families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.

A federal judge in Florida ruled on Jan. 31 that the Affordable Care Act is unconstitutional.

The ruling and the direction of his opinion were expected.

The suit was filed in March 2010 by 20 states; in the last month, another 6 states joined. Two private citizens and the National Federation of Independent Business also joined the suit. The parties challenged the law’s requirement that individuals purchase health insurance and also the ACA’s requirement that Medicaid eligibility be expanded to offer insurance to more Americans.

In his 78-page decision (pdf), Judge Roger Vinson of the U.S. District Court for the Northern District of Florida in Pensacola said that the individual mandate exceeds Congress’ regulatory powers.

"The individual mandate falls outside the boundary of Congress’ Commerce Clause authority and cannot be reconciled with a limited government of enumerated powers," he wrote. "By definition, it cannot be ‘proper’."

Judge Vinson also ruled that the whole law would have to be struck down, as the individual mandate could not be separated out from the ACA, in part because the legislation appeared to be built on a framework that required all the pieces for it to work.

"If...the statute is viewed as a carefully balanced and clockwork-like statutory arrangement comprised of pieces that all work toward one primary legislative goal, and if that goal would be undermined if a central part of the legislation is found to be unconstitutional, then severability is not appropriate," he wrote.

While the judge agreed with the plaintiff’s argument that the mandate exceeded Congress’ authority, he did not agree with their proposition that the government was overreaching through its proposed Medicaid expansion.

The plaintiffs failed to provide ample evidence of its claims, Judge Vinson ruled. As a result, "the states have little recourse to remaining the very junior partner in this partnership," he wrote.

The White House characterized the ruling as outside the mainstream of judicial thinking and said that the Administration would continue implementing health reform while it appeals. During a background briefing, senior administration officials said that Judge Vinson’s decision that there was no severability in this case flew in the face of legal precedent.

And, on the White House blog, Stephanie Cutter, a senior advisor to President Obama, wrote, "This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings, and patient protections that were included in the law at risk."

The Department of Justice issued a statement that it was still analyzing the decision, but said that, "there is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal."

After the ruling, House Speaker John Boehner (R-Ohio) said in a statement that the decision "affirms the view, held by most of the states and a majority of the American people, that the federal government should not be in the business of forcing you to buy health insurance and punishing you if you don’t."

Rep. Boehner filed a friend of the court brief on behalf of the plaintiffs.

"All parties involved should request that this case be sent to the U.S. Supreme Court for a swift and fair resolution," he said in the statement.

Ron Pollack, executive director of Families USA, which filed a brief on behalf of the federal government, said in a statement, "Judge Vinson’s decision is radical judicial activism run amok, and it will undoubtedly be reversed on appeal."

He also said that if the decision is not reversed, "it would have devastating consequences for America’s families."

Most court watchers expect the case to end up at the Supreme Court. A federal judge in Virginia also ruled against the insurance mandate in December; two other judges have upheld the ACA.