By NextBestFitNursing facilities & continuing-care communities
UHP pays for the clinical and personal-care component of nursing-home stays. Residents still contribute toward room and board on an income-tested scale, as in Canadian provinces; we estimate that keeps 45% of today's out-of-pocket nursing spending out of pocket. Medicare's short-stay rates are about 30% above the blended reference rate; Medicaid's are about 15% below it.
Result
$225.7B
$219.9B → $225.7B
Per resident, per year
$662
÷ 341.1M people
Per household
$1,708
÷ 132.2M households
Range
$223.6B–$230.0B
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) | $219.9B | |
| 2 | Private health insurance paid $19.3B at 1.20× the reference price → volume Sources: CMS Office of the Actuary (2025) | $19.3B ÷ 1.20× | $16.1B |
| 3 | Medicare paid $47.3B at 1.30× the reference price → volume Sources: CMS Office of the Actuary (2025) | $47.3B ÷ 1.30× | $36.4B |
| 4 | Medicaid paid $78.9B at 0.85× the reference price → volume Sources: CMS Office of the Actuary (2025) | $78.9B ÷ 0.85× | $92.8B |
| 5 | Out-of-pocket spending in 2024 Sources: CMS Office of the Actuary (2025) | $48.7B | |
| 6 | Stays out of pocket (items UHP excludes: 45%) | $48.7B × 45% | $21.9B |
| 7 | Covered out-of-pocket converted to reference-price volume | ($48.7B − $21.9B) ÷ 1.10× | $24.3B |
| 8 | Care UHP takes over, valued at 2024 prices | $172.3B | |
| 9 | Same care valued at the reference price (Blended Medicare/Medicaid nursing facility rate) | $169.6B | |
| 10 | Re-priced at UHP rate 1.00× | $169.6B × 1.00× | $169.6B |
| 11 | Price effect (same care, new prices) | $169.6B − $172.3B | −$2.6B |
| 12 | Utilization multiplier 1.05× | $169.6B × 1.05× | $178.1B |
| 13 | Utilization effect (more care) | $178.1B − $169.6B | $8.5B |
| 14 | UHP spending on this service | $178.1B | |
| 15 | Plus spending that stays out of pocket | $21.9B | |
| 16 | Plus Other insurance programs (CHIP, DoD, VA) (continues unchanged) | $7.0B | |
| 17 | Plus Other third-party payers & programs (continues unchanged) | $18.7B | |
| 18 | Total national spending on this service under the plan | $178.1B + $21.9B + $25.7B | $225.7B |
| 19 | Change from 2024 | $225.7B − $219.9B | $5.8B |
Trade-off: Providers of this service receive $2.6B less for the same care; patients receive $8.5B more care.