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A lot has changed in the past decade — a recession, a recovery, the passage and implementation of a landmark health care law. But some things you can always count on — like health care spending continuing to climb steadily higher every year.

Per-person health care spending rose by 44%, or about 4% per year, from 2007 to 2016, according to new research published in Health Affairs.

• This analysis only includes employer-based health insurance, making the Affordable Care Act a less significant factor. It also doesn’t include premiums — just spending on actual care.

Warning sign: Spending growth slowed immediately after the recession but is now increasing at roughly pre-recession levels.

Winners: Doctors and outpatient hospital facilities drove the bulk of the spending increases, followed by inpatient hospital care.

Deductibles have also risen over the same time period. So, not only are costs going up, but workers are spending more of their own money, out of pocket, to cover those costs.

Clinical trials don’t enroll enough black participants, even when they’re testing drugs for treatments that disproportionately affect African-Americans, according to a ProPublica analysis.

By the numbers: In most of the trials ProPublica surveyed, less than 5% of participants were black — compared with more than 13% of the U.S. population.

• The results weren’t much better even for treatments that could disproportionately benefit black people, such as multiple myeloma and prostate cancer. These are more prevalent among African-Americans, yet black enrollment in trials for those drugs still often sat around 2% or 3%.

Why it matters: It’s not entirely clear why some diseases affect different populations differently, but those differences are an important part of understanding whether a particular treatment is safe and effective — exactly what clinical trials are supposed to test.

Go deeper: NIH launches massive program to diversify medical research

Employers already work with Fitbit by buying the wearable fitness tracker and giving it to workers in the hopes they’ll exercise and stay healthy. Now, my colleague Bob Herman reports, Fitbit is doubling down on employer wellness programs with a few new bells and whistles like “health coaching.”

Between the lines: Fitbit’s revenue has been on the decline for the past couple years, and it’s also lost a whopping half-billion dollars since the start of 2016. Racing toward the flowing spigot of employer wellness programs may be a good way to reassure investors.

The big picture: The most authoritative research on wellness programs, which you can read here, says it all: “The evidence on wellness programs is discomfiting. Most programs do not work; some raise serious legal concerns. It is time for employers and policymakers to rethink their enthusiasm for the wellness movement.”

Separately, John Hancock, one of the largest North American life insurers, announced yesterday it will only sell policies that include the tracking of fitness and health data through wearable devices and smartphones.

A super PAC supporting Leah Vukmir, the Republican challenging Democratic Sen. Tammy Baldwin for her Wisconsin Senate seat, is up with a new ad hitting Baldwin over her support for “Medicare for All.”

• The ad emphasizes the cost of the proposal, an attack that’s growing in popularity as the midterm elections approach.

Between the lines: We're seeing more of these ads for two big reasons...

• Republicans are trying to rile up a complacent base in a year when Democrats could not possibly be more energized.
• Democrats are winning the health care issue, which they wanted to put front and center this year.

Well, they’re not fun to have. But, via the New York Times, they’re surprisingly pleasing to look at.

Who knew?