By NextBestFitHome health care
Medicare's home-health payment becomes the national rate. Utilization rises 20% because long-term home care is covered without the Medicaid asset test.
Result
$204.5B
$169.4B → $204.5B
Per resident, per year
$600
÷ 341.1M people
Per household
$1,547
÷ 132.2M households
Range
$196.6B–$220.4B
Lean and costly scenarios.
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | 2024 spending on this service (CMS NHE Table 4) Sources: CMS Office of the Actuary (2025) | $169.4B | |
| 2 | Private health insurance paid $37.3B at 1.10× the reference price → volume Sources: CMS Office of the Actuary (2025) | $37.3B ÷ 1.10× | $33.9B |
| 3 | Medicare paid $55.7B at 1.00× the reference price → volume Sources: CMS Office of the Actuary (2025) | $55.7B ÷ 1.00× | $55.7B |
| 4 | Medicaid paid $38.2B at 0.85× the reference price → volume Sources: CMS Office of the Actuary (2025) | $38.2B ÷ 0.85× | $44.9B |
| 5 | Out-of-pocket spending in 2024 Sources: CMS Office of the Actuary (2025) | $30.4B | |
| 6 | Stays out of pocket (items UHP excludes: 20%) | $30.4B × 20% | $6.1B |
| 7 | Covered out-of-pocket converted to reference-price volume | ($30.4B − $6.1B) ÷ 1.00× | $24.3B |
| 8 | Care UHP takes over, valued at 2024 prices | $155.5B | |
| 9 | Same care valued at the reference price (Medicare home health rates) | $158.9B | |
| 10 | Re-priced at UHP rate 1.00× | $158.9B × 1.00× | $158.9B |
| 11 | Price effect (same care, new prices) | $158.9B − $155.5B | $3.4B |
| 12 | Utilization multiplier 1.20× | $158.9B × 1.20× | $190.6B |
| 13 | Utilization effect (more care) | $190.6B − $158.9B | $31.8B |
| 14 | UHP spending on this service | $190.6B | |
| 15 | Plus spending that stays out of pocket | $6.1B | |
| 16 | Plus Other insurance programs (CHIP, DoD, VA) (continues unchanged) | $1.7B | |
| 17 | Plus Other third-party payers & programs (continues unchanged) | $6.1B | |
| 18 | Total national spending on this service under the plan | $190.6B + $6.1B + $7.8B | $204.5B |
| 19 | Change from 2024 | $204.5B − $169.4B | $35.1B |
Trade-off: Prices rise $3.4B (to raise access or wages) and patients receive $31.8B more care.