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Medicare is the largest purchaser of health care services in the country, and over the past decade, there's been a gradual change in how those taxpayer dollars are spent, according to data from the independent Medicare Payment Advisory Commission.

Since 2006, Medicare is shifting money from physician practices and inpatient hospitals (where a person needs an overnight stay), and toward private health insurers and other companies that run the Medicare Advantage and Part D prescription drug programs. Spending also has increased in outpatient settings.

Expand chart

Why it matters: The Affordable Care Act contributed to some of this shift by cutting Medicare payments to hospitals. But what's happening in Medicare is representative of the health care system at large: the shift to defined benefits and narrow networks of hospitals and doctors, and avoiding hospitalizations whenever possible.

Where more Medicare funds are flowing:

  • Medicare Advantage: Roughly 20 million seniors and disabled people are now enrolled in the politically popular program, which represents 27% of all Medicare dollars. Seniors give those plans high marks, and it's a profitable business for insurers. But there are concerns that Medicare Advantage isn't saving money and that insurers are gaming the program.
  • Part D: The growth of drug prices has blown away the growth of pretty much every other economic good, and Medicare is barred from negotiating discounts with manufacturers. That inevitably has resulted in more money going into the Part D program (14% of all Medicare spending), and the benefits managers that run it.
  • Outpatient hospital departments and clinics: Technology has made it possible for Medicare enrollees to get some procedures and go home the same day, and it's cheaper than treating someone in the hospital. But hospitals also have been buying physician offices and controversially converting them into hospital outpatient departments, resulting in higher fees for the same services.

Go deeper

Pelosi announces bid for re-election ahead of 2022 midterms

House Speaker Nancy Pelosi (D-Calif.) announced her bid for re-election Tuesday, amid a deluge of other safe-seat Democrats announcing their retirements.

Why it matters: Pelosi’s announcement follows months of speculation — despite her denials — that she was preparing to leave Congress.

Scoop: Qatar emir to visit White House on Monday

The emir of Qatar, Tamim bin Hamad Al Thani, leaves the White House after meeting President Trump in 2019. Photo: Nicholas Kamm/AFP via Getty Images

The emir of Qatar will meet with President Biden at the White House on Monday to discuss Afghanistan as well as contingency plans to provide natural gas to Europe in the event of a Russian invasion of Ukraine, Axios has learned.

Why it matters: Europe's reliance on Russia for 40% of its natural gas is undermining Biden's attempts to coordinate "massive" sanctions to be imposed from both sides of the Atlantic if Russia invades. The White House wants Qatar to help ensure European countries can enforce tough sanctions without risking an energy crisis.

Biden: There won't be "American forces moving into Ukraine"

President Joe Biden told reporters Tuesday that he does not foresee U.S. troops moving into Ukraine.

Why it matters: Biden's comments come as tensions between Russia and Ukraine persist, and a Russian invasion of Ukraine appears increasingly likely.