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Expand chart
Data: Centers for Medicare & Medicaid Services' Office of the Actuary; Chart: Axios Visuals

Americans spent $3.65 trillion on health care in 2018 — 4.6% more than the year before. That growth also was higher than the 4.2% rate from 2017, according to revised figures from independent federal actuaries.

Between the lines: U.S. health care spending climbed again not because people went to the doctor or hospital more frequently, but because the industry charged higher prices. And private health insurers didn't do a particularly good job negotiating lower rates.

By the numbers: The 4.6% growth rate in 2018 was revised up slightly from preliminary numbers released in February, and it came in below the broader economic growth rate.

  • All other figures on what Americans spent on hospitals, doctors and prescription drugs sold at pharmacies also were similar to February's report.

The intrigue: The number of people with private health plans — which mostly consists of the coverage people get through their jobs — dipped in 2018, yet the amount spent per person soared 6.7%.

  • That is the highest per-enrollee spending growth rate among people with private health insurance since 2004, actuaries wrote.
  • Part of that increase was due to higher premiums that insurance companies passed on from the Affordable Care Act's health insurance tax.
  • More importantly: Hospitals, doctors and drugmakers continued to wring out much higher rates from private insurers thanks to provider mergers and perverse negotiating incentives.

Medicare and Medicaid had much lower per-enrollee spending growth rates in 2018 than private insurance, but those figures were the highest they've been since 2015 — again due to higher costs for the private insurers that are increasingly running those government programs.

Go deeper

California governor declares drought emergency in most counties

A sign in April on the outskirts of Buttonwillow in California's Kern County, one of the top agriculture producing counties in the San Joaquin Valley, after historically low winter rainfall. Photo: Frederic J. Brown/AFP via Getty Images

California Gov. Gavin Newsom (D) extended a drought emergency declaration to cover 41 of the state's 58 counties on Monday.

Why it matters: Most of California and the American West are experiencing an "extreme" or "exceptional" drought, per the U.S. Drought Monitor. Newsom and other officials are concerned California could experience a repeat of the catastrophic 2020 wildfire season.

3 hours ago - World

Jerusalem crisis escalates after Hamas and Israel trade rocket fire

Israeli air strikes in the southern Gaza Strip on May 10. Photo: Said Khatib/AFP via Getty Images

Nine children were among 20 Palestinians killed in Israeli airstrikes after Hamas fired dozens of rockets at Jerusalem for the first time since 2014 Monday, per AP and Reuters.

The big picture: The rockets come after escalating violence in Jerusalem has injured 250 Palestinians and several Israeli police officers during protests over the planned evictions of Palestinian families from their homes that began Friday.

Pelosi's Republican playbook

Illustration: Aïda Amer/Axios

As Republicans fight among themselves, House Speaker Nancy Pelosi (D-Calif.) is showing the myriad ways she deals with the GOP herself.

Between the lines: We've seen Pelosi cut opponents off at the knees, like she did with President Trump, or pretend to forget their names, as she did to Sen. Ron Johnson (R-Wis.). Now she's feeding oppo research against her House counterpart, Minority Leader Kevin McCarthy (R-Calif.), so others can use the same harsh rhetoric to frame the Republicans as the party of dysfunction.