Health Issues

An updated collection of charts examines the anticipated growth in health spending over the next few years, focusing on trends in prescription drug costs, out-of-pocket expenses, and other related factors.

In 2024, the growth in per capita health spending is projected to slow down to 4.5%. Expectations indicate a further decline in growth rates for 2025 and 2026, anticipated at 4.2% and 4.3%, respectively. From 2027 to 2032, average annual growth in per capita spending is expected to stabilize at around 5.0%. Throughout this timeframe, national health expenditures are likely to exceed GDP growth, primarily due to rising medical prices.

The insights presented in this chart collection utilize the 2022 National Health Expenditure (NHE) projections provided by federal actuaries. For more analyses and information, visit the Peterson-KFF Health System Tracker, a resource hub focused on monitoring and evaluating the U.S. health system’s performance.

National health expenditure reached $4.5 trillion in 2022, accounting for 17% of the gross domestic product (GDP), and is expected to outpace GDP growth through 2032. This growing expenditure is likely to increase costs for families, employers, states, and the federal government. As policymakers explore various strategies to enhance health care affordability, they are paying close attention to the effects of market consolidation in health care and its potential impact on costs and quality of care. Hospital consolidation is a primary focus because nearly one third of all health care spending is directed towards hospital services. While consolidation could enable providers to function more efficiently and assist struggling providers in underserved areas, it frequently results in diminished competition. A wealth of evidence indicates that consolidation can lead to increased prices, with ambiguous effects on quality.

This analysis investigates the competitiveness of hospital care markets by using RAND Hospital Data, a refined version of cost reports from Medicare-certified hospitals, along with American Hospital Association (AHA) survey data. For conciseness, the terms “independent hospitals” and “health systems” will both be referred to as “health systems.” Competition is quantified in three different ways: the proportion of metropolitan statistical areas (MSAs) dominated by a limited number of health systems, the level of market concentration in MSAs using the Herfindahl-Hirschman Index (HHI), and the evolving share of hospitals associated with health systems. This analysis concentrates on general short-term or general medical and surgical hospitals based on 2022 data, excluding federal hospitals (see Methods for more information).

Key Takeaways

• In 2022, one or two health systems monopolized the entire market for inpatient hospital care in nearly half (47%) of metropolitan areas.
• In over 82% of metropolitan areas, one or two health systems commanded more than 75 percent of the market.
• Almost all (97%) metropolitan areas exhibited highly concentrated inpatient hospital care markets when applying HHI thresholds from antitrust guidelines.

One or Two Health Systems Dominated the Entire Market for Inpatient Hospital Care in Nearly Half (47%) of Metropolitan Areas in 2022

A single health system controlled nearly one in five (19%) metropolitan statistical areas (MSAs), while over one in four (27%) markets were governed by two systems in 2022 (see Figure 1). In more than four out of five metropolitan areas (82%), one or two health systems ruled over more than 75 percent of the market. All these markets classified as highly concentrated according to current antitrust guideline definitions (outlined below). One health system held at least half the market share in three out of four MSAs (75%) and at least a quarter of the market in almost every MSA (98%).

The number of health systems within an MSA generally increases in line with the region’s population. For instance, in 79% of MSAs with populations under 200,000, one or two health systems controlled the market for inpatient hospital care in 2022, as seen in locations such as Muncie, IN; Napa, CA; and Amherst Town-Northampton, MA (Figure 2). MSAs with one or two health systems represent nearly half (47%) of all MSAs but only 12% of the U.S. metropolitan population.

On the other hand, almost all (53 out of 54) MSAs with populations of one million or more had at least four health systems, as is the case for Detroit, Miami, and Phoenix. These MSAs with four or more health systems make up 35% of all MSAs and 79% of the U.S. population residing in metropolitan areas.

However, in nine of these relatively large MSAs with four or more systems, the two largest health systems had control over at least 75% of the market. Moreover, in 37 of these markets, they accounted for at least 50%. For instance, in the MSA encompassing Austin, TX, with a population of 2.4 million, two systems (HCA Healthcare and Ascension Health) dominated 85% of the inpatient hospital care market, even though Austin hosts more than four health systems. The metropolitan area covering Portland, OR, with a population of 2.5 million and also more than four health systems, showcases a slightly less concentrated market compared to Austin’s; however, the two largest systems (Legacy Health and Providence) still collectively hold 56% of the market. (Refer to Methods for a discussion regarding MSAs as hospital market geographies).

Nearly all (97%) metropolitan areas had highly concentrated markets for inpatient hospital care in 2022 based on current antitrust guidelines

Another approach to evaluating market competitiveness involves analyzing concentration through the Herfindahl-Hirschman Index (HHI), which gauges the number of competitors in a market and their market shares. The scale ranges from 0 (indicating perfect competition) to 10,000 (indicating a monopoly). According to current merger guidelines from the Federal Trade Commission (FTC) and Department of Justice (DOJ), markets are categorized as: not concentrated (HHI < 1,000), moderately concentrated (1,000 – 1,800), and highly concentrated (HHI > 1,800). This analysis calculates HHIs for MSAs and classifies these regions accordingly, although alternative market boundary definitions can yield different competition levels (see Methods).

In 2022, nearly all (97%) MSAs showed high market concentration for inpatient hospital care, based on HHI thresholds from current merger guidelines (Figure 3). These guidelines reflect 2023 updates that lowered the HHI thresholds for moderately and highly concentrated markets. Under previous guidelines, a large proportion—though marginally smaller (93%)—of MSAs were classified as highly concentrated markets, corroborating an estimation from a previous study (90%) using 2016 data.

Similar to the findings regarding the number of health systems in MSAs, more populated metropolitan areas generally tended to be less concentrated and more competitive than those with smaller populations, though this wasn’t universally true. All 13 MSAs identified as either not concentrated or moderately concentrated had populations exceeding one million, including places like Cincinnati, Oklahoma City, and Miami. Nevertheless, 41 MSAs with populations greater than one million—including Houston, Denver, and Atlanta—exhibited highly concentrated hospital markets. Overall, 70% of individuals residing in metropolitan areas lived in highly concentrated hospital markets.

The proportion of hospitals affiliated with health systems rose from 56% in 2010 to 67% in 2022, with growth observed in both rural and nonrural areas

As of 2022, approximately two-thirds of hospitals (67%) are affiliated with larger systems, a rise from 56% in 2010 (Figure 4). A lower percentage of rural hospitals than nonrural ones were part of a health system in 2022 (52% vs. 83%), though both rural and nonrural areas have seen an upward trend: from 43% in 2010 to 52% in 2022 among rural hospitals, and from 69% in 2010 to 83% in 2022 among nonrural hospitals.

As of 2022, the majority of system-affiliated hospitals (53%) belonged to systems with at least 15 hospitals, while 22% were part of systems with 50 or more hospitals. Systems with at least 100 hospitals accounted for 13% of system-affiliated hospitals.

Hospital consolidations into larger systems do not always result in diminished local market competition, especially if an independent hospital is absorbed by a larger system that lacks existing facilities in that locality. Nonetheless, mergers across hospitals that serve distinct geographic markets for patient care—termed “cross-market” mergers—may still lead to escalated prices in certain instances.

In 2022, nearly half (47%) of metropolitan areas across the nation had only one or two hospitals or health systems offering general inpatient hospital care, according to a recent KFF analysis.

The analysis explores the level of competition among hospitals amidst a surge of hospital consolidations that has garnered the attention of both state and federal regulators. Approximately one in five (19%) metropolitan statistical areas are served by just one hospital or health system, while more than a quarter (27%) are under the control of two hospitals or systems.

In a vast majority of metropolitan areas (82%), one or two hospitals or health systems accounted for at least three-quarters of all inpatient hospital discharges, thus fulfilling the criteria for highly concentrated markets as outlined by current federal antitrust standards.

The quantity of hospitals or health systems in a metropolitan area commonly increases with the population size of the region. A significant majority of smaller metropolitan areas (fewer than 200,000 residents) have only one or two hospitals or health systems providing inpatient care, while almost all of the largest areas (with at least one million residents) host a minimum of four hospitals or health systems.

Additional findings include:

• Almost all (97%) metropolitan areas exhibited highly concentrated markets for inpatient hospital care in 2022, as measured by the Herfindahl-Hirschman Index, which assesses the market shares of participants in a specific market. This metric is utilized by the Federal Trade Commission and Department of Justice in their current guidelines for evaluating hospital or health system mergers.
• Two-thirds (67%) of hospitals across the country were affiliated with health systems in 2022, an increase from 56% in 2010. This rise in affiliated hospitals impacted both rural and urban areas, despite the fact that nearly half (48%) of hospitals in rural regions remain independent of larger health systems.

Immigrant adults represent a diverse segment of the population, constituting 16% of adults in the United States and significantly contributing to the nation’s workforce and communities. As we approach the 2024 election, anti-immigrant sentiment has surged, with immigration becoming a focal issue for various candidates. The Trump campaign has frequently labeled immigrants as contributors to crime, a financial burden on taxpayers, and a liability for government programs such as Medicare and Social Security. Meanwhile, the Harris campaign has centered its immigration narrative around her strong law enforcement background as a former attorney general in a border state, while also emphasizing her family’s immigrant heritage. Certain states have enacted restrictive measures aimed at immigrants, including mandates for hospitals to gather patient immigration status.

In light of this rhetoric and recent state actions, information on immigrants’ health care utilization and costs, as well as their economic contributions, particularly in the health care sector, is essential. This brief presents important data on these subjects, utilizing KFF analysis from various sources, including the KFF/LA Times Survey of Immigrants, the largest nationally representative survey of immigrants conducted to date, along with other studies.

Immigrants are no more likely than U.S.-born citizens to report using government assistance for food, housing, or health care; undocumented immigrants remain ineligible for federally funded assistance.

The 2023 KFF/LA Times Survey of Immigrants reveals that, despite experiencing lower household incomes and encountering financial difficulties, immigrant adults are just as likely as U.S.-born adults to state that they or someone in their household received government assistance for food, housing, or health care in the last year. In fact, approximately one-quarter (28%) of both immigrant adults and U.S.-born citizen adults reported receiving such assistance within the past 12 months (Figure 1).

Lawfully present immigrants face eligibility restrictions for federal programs like Medicaid and the Children’s Health Insurance Program (CHIP). Generally, lawfully present immigrants must possess a “qualified status” to access Medicaid or CHIP. Many, including most lawful permanent residents or green card holders, must wait five years after achieving qualified status before enrolling, provided they meet all other eligibility criteria. Some lawfully present immigrants, such as refugees and asylees, are exempt from this five-year waiting period. Additionally, states can expand coverage to lawfully residing immigrant pregnant individuals and children without this waiting period. Lawfully present immigrants can also purchase coverage through the Affordable Care Act (ACA) Marketplace and qualify for tax credits to help lower their costs immediately. Those meeting the work requirements can enroll in Medicare, while others may purchase Medicare Part A after maintaining legal residence in the U.S. for five consecutive years.

Undocumented immigrants cannot enroll in federally funded programs like Medicaid, CHIP, or Medicare, nor can they buy coverage through the ACA Marketplaces. Medicaid can cover emergency services for individuals eligible for Medicaid but for their immigration status. Emergency conditions encompass those that threaten the individual’s health or result in serious bodily impairment, although states hold discretion regarding what services qualify for Emergency Medicaid reimbursement.

Some states have initiated fully state-funded programs to extend coverage to immigrants regardless of status, although the eligibility criteria and benefits provided vary. Studies indicate that expanding health coverage for immigrants can lead to decreased rates of uninsurance, increased health care utilization, reduced costs, and improved health outcomes.

Immigrants, especially undocumented ones, utilize health care services, including emergency care, less than U.S.-born individuals.

Research indicates that immigrants, both lawfully present and undocumented, engage less with health care services than U.S.-born citizens. The KFF/LA Times Survey of Immigrants shows that undocumented immigrants are less likely to seek or receive care in the U.S. compared to lawfully present immigrants and naturalized citizens. Approximately 63% of likely undocumented immigrant adults report having a health care visit in the past year, compared to 74% of lawfully present immigrant adults and 82% of naturalized citizen adults.

This lower health care utilization among immigrants can be attributed to their overall healthier and younger demographics, along with increased barriers such as language access issues, confusion, and fears related to immigration. Analysis from KFF indicated that policies from the Trump administration intensified these fears and led to increased hesitance in seeking care.

Immigrants incur lower health care costs compared to U.S.-born individuals.

Reflecting their reduced health care utilization, immigrants exhibit lower health care expenditures than their U.S.-born counterparts. KFF’s analysis of 2021 medical expenditure data indicates that the average annual per capita health care expenditures for immigrants are about two-thirds that of U.S.-born citizens ($4,875 vs. $7,277) (Figure 3). This includes lower spending across various health care services such as office visits, prescription medications, inpatient and outpatient care, and dental services. These findings support other research revealing that immigrants’ overall health expenditures range from half to two-thirds compared to those of U.S.-born individuals, irrespective of immigration status, with lower per capita expenses noted across private and public insurance sources, especially among undocumented immigrants. A particular study highlighted that undocumented immigrants tend to be uninsured and have significantly reduced yearly health care expenditures compared to U.S.-born individuals, with no substantial differences in rates of uncompensated care between the two groups.

Immigrants bolster the economy through their workforce participation and tax contributions, with evidence suggesting they help subsidize health care for U.S.-born individuals and bolster Medicare and Social Security.

Immigrants play a crucial role in addressing the nation’s labor shortages by occupying unmet manufacturing and service needs, with research indicating they do not displace U.S.-born workers. Their contributions are particularly evident in essential sectors such as construction and agriculture, which are vulnerable to health risks and injuries, including climate-related hazards. Furthermore, immigrants, alongside their adult children, significantly enhance the health care workforce, serving as physicians, surgeons, nurses, and long-term care workers (Figure 4). With ongoing projections of shortages in health care employment and a growing population aged 65 and older, immigrants could be pivotal in alleviating these workforce deficits.

Studies show that undocumented immigrants contribute billions yearly in federal, state, and local taxes, with more than a third attributed to payroll taxes funding programs they cannot access, such as Social Security and Medicare. Additional research indicates that immigrants contribute more to the health care system than they use through taxes and premiums, effectively subsidizing health care for U.S.-born citizens. Earlier studies found that without the input of undocumented immigrants into the Medicare Trust Fund, it would face insolvency sooner, and demonstrably, undocumented immigrants positively impact the financial health of Social Security.

Starting Nov. 1, 2024, Georgia residents will use a state-run health insurance enrollment platform, Georgia Access, to shop for and enroll in Marketplace health coverage for 2025. ^{Here’s a look at the changes that consumers can expect:}

* HealthInsurance.org, LLC and INSXCloud, Inc. indirectly share common corporate ownership.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

Key Takeaways

• The Biden administration recently announced a projected reduction of out-of-pocket costs for seniors as part of the Medicare drug negotiations, yet large majorities of voters have not heard about these savings, with almost half (45%) who say they have heard “nothing at all,” while a quarter have heard “a lot” or “some.” Larger shares of older voters, those ages 65 and older, say they’ve heard “a lot” or “some” about these savings, with a third (32%) who say so, compared to two in ten (22%) of those under age 65. Most voters continue to be unaware of the Medicare drug pricing provisions in the Inflation Reduction Act, or IRA, that was passed by Congress and signed into law by President Biden more than two years ago, though awareness of some of the provisions is higher among older voters – the group most impacted by the provisions.
• While awareness of Medicare drug negotiations continues to lag, KFF finds widespread support for this policy. Majorities of voters support authorizing the federal government to negotiate drug prices, while one in seven (14%) oppose. This provision is supported by nine in ten Democrats and independent voters (92% and 89%, respectively) and three-quarters of Republican voters (77%). It is also supported by 88% of older adults, those ages 65 and over, including majorities across partisans.
• Voters’ views of who is responsible for the legislation as well as the expected savings from the negotiations are largely partisan. Overall, a slight majority (55%) of voters ages 65 and older think Medicare negotiating will lower their own prescription drug costs, but the share who expect to see savings increases to nearly two-thirds (64%) of older Democratic and Democratic-leaning voters. On the other hand, about half (52%) of older Republican and Republican-leaning voters say they don’t expect the negotiations to have any impact on their drug costs. In addition, voters are also more likely to give their own party leaders credit for passing legislation aimed at lowering the price of prescription drugs for people on Medicare, though Republican voters are less enthusiastic about their party leaders’ roles. Larger shares of Democratic voters than Republican voters say President Biden, Vice President Harris, and the Democrats in Congress played a “major” or “minor” role in passing legislation for lowering drug prices for people on Medicare, while Republican voters are more likely than Democratic voters to say the same about Republicans in Congress. A similar share of Republican voters give former President Trump credit for passing the legislation as give credit to President Biden.
• Vice President Harris’ campaign has announced proposals for expanding some of the IRA provisions beyond those with Medicare coverage. Majorities of voters, overall and across partisanship, support these proposed provisions, though smaller shares of Republicans are on board. Three-quarters (77%) of voters support the proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democratic voters (84%), independent voters (79%), and Republican voters (70%). Seven in ten (69%) voters support the proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 83% of Democrats, 70% of independents, and 58% of Republicans.

Most Voters Continue to Be Unaware of IRA Provisions to Reduce Prescription Drug Prices

Most voters continue to be unaware of the Medicare drug pricing provisions in the Inflation Reduction Act, or IRA, that was passed by Congress and signed into law by President Biden more than two years ago, though awareness of some of the provisions is higher among older voters – the group most impacted by the provisions.

Four in ten voters are now aware there is a federal law in place that caps the cost of insulin for people with Medicare at $35 per month, while another third (35%) are aware of the law that requires the federal government to negotiate the price of some prescription drugs for people with Medicare. A quarter of voters (27%) are aware of the federal law that places a limit on out-of-pocket prescription drug costs for people with Medicare, and one in eight (12%) are aware that there is a law in place that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare.

Larger shares of voters ages 65 and older are aware of some of these drug pricing provisions of the IRA. For example, six in ten (61%) voters ages 65 and older are aware of the law that caps the cost of insulin for people with Medicare and about a third (34%) of older voters are aware of the provision that places an out-of-pocket limit on prescription drug costs. Similar shares of older voters compared to younger voters are aware of the provision that requires the government to negotiate the price of some prescription drugs and that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare.

While awareness of the Medicare drug pricing provisions increased, especially among older voters, from November 2023 to May 2024, awareness has remained steady over the past several months.

Voters Remain Unaware of Impact of Medicare Drug Negotiations, Older Adults Are Unclear if It Will Reduce Their Prescription Costs

The Biden administration recently announced that the lower prices negotiated for some prescription drugs would have saved the federal government $6 billion in 2023 with an estimated $1.5 billion reduction in out-of-pocket costs for older adults when lower prices take effect in 2026. Large majorities of voters have not heard about these projected savings, with almost half (45%) who say they have heard “nothing at all” about the negotiations, while a quarter (25%) have heard “a lot” or “some.” Another three in ten (30%) have heard “a little” about the negotiations.

Larger shares of older voters, those ages 65 and over, say they’ve heard “a lot” or “some” about these savings, with a third (32%) who say so, compared to one in five (22%) of those under age 65.

Similarly, larger shares of Democratic and independent voters have heard about the projected savings, with about a third (34%) of Democrats and a quarter (27%) of independents who have heard at least “some,” compared to about one in six (16%) Republican voters.

Overall, almost nine in ten (85%) voters support authorizing the federal government to negotiate drug prices, while one in seven (14%) oppose. This provision is supported by 92% of Democratic voters, 89% of independent voters, and 77% of Republican voters. While support for the law is lower among Republicans, most Republican voters support it.

In addition to supporting the federal government negotiations, a slight majority (55%) of voters ages 65 and older think Medicare negotiations will lower their own prescription drug costs, while four in ten (43%) older voters think negotiating won’t have any impact on their prescription drug costs. Expectations that Medicare negotiations won’t lower drug costs seem to be partisan, with two-thirds (64%) of older Democratic and Democratic-leaning voters thinking it will lower their drug costs, while about half (52%) of older Republican and Republican-leaning voters thinking it won’t have any impact on their drug costs.

The Inflation Reduction Act was enacted under President Biden without any Republican support in Congress. Six in ten voters say President Biden had a “major” or “minor” role in passing the recent law aimed at lowering drug prices for people on Medicare, including four in ten (37%) who say he had a “major” role. Similar shares of voters say the same about Democrats in Congress, with six in ten (60%) who say they played a “major” or “minor” role. Another four in ten (42%) voters say Vice President Harris played a role. Credit for the recent law could be key as she picks up these issues on her own platform for president.

Almost half (46%) of voters think that Republicans in Congress played a role in passing the recent law, with a small share saying they played a “major” role (14%). About a quarter of voters credit former President Trump for the passage of the law aimed at lowering drug prices for those on Medicare, with a quarter (28%) who say he played a “major” or “minor” role, while 41% say he had no role in passing the recent law. Between a quarter and a third of voters aren’t sure how big of a role these groups played in the health care legislation.

Partisans are more likely to give their own party leaders credit for passing legislation aimed at lowering the price of prescription drugs for people on Medicare, though Republican voters are less enthusiastic about their party leaders’ roles. Larger shares of Democratic voters than Republican voters say President Biden, Vice President Harris, and the Democrats in Congress played a “major” or “minor” role in passing legislation for lowering drug prices for people on Medicare. While Republican voters are more likely than Democratic voters to say former President Trump and the Republicans in Congress played a role, only about a quarter of Republican voters said either (23% and 24%, respectively) played a “major role.” In fact, a similar share of Republican voters give former President Trump credit for passing the legislation as give credit to President Biden.

Overall, eight in ten (81%) Democratic voters say Biden played a role in passing the legislation, four in ten (39%) of Republican voters say the same about Trump. Another eight in ten Democratic voters say Democrats in Congress played a “major” or “minor” role in passing the legislation, while over half (54%) of Republicans say the same about Republicans in Congress.

Voters Support Expanding on IRA Provisions

Vice President Harris’ campaign has announced that, if elected, her administration hopes to expand some of the drug pricing legislation beyond just those with Medicare, allowing others to benefit from the cap on monthly out-of-pocket costs for those with insulin and the annual limit on out-of-pocket prescription drug costs. Former President Trump has remained silent on some of these issues, though his administration implemented a program under which Medicare plans voluntarily lowered insulin copays to $35 per month. Majorities of voters, overall and across partisanship, support these proposed provisions, though smaller shares of Republicans are on board. Three-quarters (77%) of voters support the proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democratic voters (84%), independent voters (79%), and Republican voters (70%). Seven in ten (69%) voters support the proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 83% of Democrats, 70% of independents, and 58% of Republicans.

Allowing Medicare to negotiate drug prices on behalf of older Americans remains broadly popular across partisans, though many voters are unaware of the new law and the billions of dollars it is expected to save in 2026, a new KFF Health Tracking Poll finds.

A large majority (85%) of voters say they support allowing the federal government to negotiate the price of some prescription drugs for people with Medicare. This includes at least three quarters of Republican (77%), independent (89%) and Democratic (92%) voters.

The Inflation Reduction Act of 2022 authorized such negotiations, and the Biden administration recently completed the first round of negotiations on 10 drugs, resulting in an estimated $1.5 billion in lower out-of-pocket costs for Medicare beneficiaries in 2026.

The poll shows that nearly two thirds (65%) of voters are unaware or unsure that there is a law allowing Medicare drug-price negotiations. The share (62%) is similar among older voters (ages 65+) who are generally covered by Medicare.

A large majority (75%) of voters also say they have not heard much about the savings resulting from the first round of price negotiations, including almost half (45%) who say they have heard “nothing at all.” 

One in four say they have heard “a lot” (4%) or “some” (21%) about the savings. Older voters are somewhat more likely to have heard either “a lot” (7%) or “some” (26%) about the savings.

Other findings include:

• Most (55%) voters ages 65 and older expect that Medicare drug-price negotiations will lower their own prescription costs, with 43% saying it will not have any impact. Older Democratic and Democratic-leaning independent voters are more likely than older Republicans and Republican-leaning independent voters to expect savings (64% vs. 45%). 

• Minorities of voters are aware of other Medicare drug-price provisions in the Inflation Reduction Act, including the $35 cap on out-of-pocket costs for insulin (40%) and limiting annual out-of-pocket prescription drug costs (27%). Older voters are more likely than younger voters to know about both of these provisions. 
• While the Inflation Reduction Act was enacted under President Biden without any Republican support in Congress, partisans are divided on who deserves credit for the law’s Medicare drug price provisions. Substantial shares of GOP voters say that Republicans in Congress (54%) and President Trump (39%) had either a “major” or “minor” role in enacting those provisions. Larger shares of Democratic voters say that Democrats in Congress (80%), President Biden (81%), and Vice President Harris (69%) had a role. 
• Most voters say they would be in favor of extending Medicare’s $35 cap on monthly insulin costs (77%) and the $2,000 limit on out-of-pocket drug spending (69%) beyond people with Medicare, as Vice President Harris has proposed. Majorities of Democrats, Republicans and independent voters support extending each of the two provisions. 

Designed and analyzed by public opinion researchers at KFF, the survey was conducted August 26-Sept. 4, 2024, online and by telephone among a nationally representative sample of 1,312 U.S. adults, including 1,084 registered voters, in English and in Spanish. The margin of sampling error is plus or minus 4 percentage points for the full sample and among registered voters. For results based on other subgroups, the margin of sampling error may be higher.

Most individuals view their health expenditures primarily as the monthly premium payments they make, along with any out-of-pocket expenses for medical services or prescription medications. Nevertheless, there is a considerable amount of health spending that remains less apparent in everyday life.

This interactive tool, recently updated with data from 2022, aids users in understanding how health care costs differ based on family size, income, insurance coverage, and health conditions. Utilize the dropdown menus to examine various scenarios and trends related to household health spending.

The tool, along with additional data on health expenses, can be found on the Peterson-KFF Health System Tracker, a dedicated online resource aimed at monitoring and evaluating the performance of the U.S. health care system.