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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

CPAC Republicans choose conservatism over constituents

Rep. Matt Gaetz. Photo: Elijah Nouvelage/Bloomberg via Getty Images

CPAC proved such a draw, conservative Republicans chose the conference over their constituents.

Why it matters: More than a dozen House Republicans voted by proxy on the $1.9 trillion COVID-19 relief bill in Washington so they could speak at the Conservative Political Action Conference, known as CPAC. And Sen. Ted Cruz skipped an Air Force One flight as President Biden flew to Cruz's hometown of Houston to survey storm damage.

Border Democrat warns Biden about immigrant fallout

Henry Cuellar (right). Photo: Tom Williams/CQ-Roll Call Inc. via Getty Images

A Democratic lawmaker representing a border district warned the Biden administration against easing up too much on unauthorized immigrants, citing their impact on his constituents, local hospitals and their potential to spread the coronavirus.

Why it matters: Rep. Henry Cuellar (D-Texas) told Axios he supports President Biden. But the moderate said he sees the downsides of efforts to placate pro-immigrant groups, an effort that threatens to blow up on the administration.

3 hours ago - World

Iran rejects nuclear talks with U.S., for now

Iranian Foreign Minister Javad Zarif at Iran/EU talks in 2015. Photo: Carlos Barria/POOL/AFP via Getty

A spokesman for Iran’s Foreign Ministry said on Sunday that conditions are not ripe for informal nuclear talks between Iran, the U.S. and other world powers.

Why it matters: The Biden administration had proposed the talks as part of its efforts to negotiate a path back to the 2015 nuclear deal. The White House expressed disappointment with Iran's response, but said it remained willing to engage with Tehran.