13.8% Inflation-adjusted GDP (billions) Cumulative growth 2009 to Q Exhibit 1 Steady U.S. Economic Growth After a Severe Recession $17,000

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1 Exhibit 1 Steady U.S. Economic Growth After a Severe Recession Inflation-adjusted GDP (billions) $17,000 $16,000 $15,000 $14,000 $13, % Cumulative growth 2009 to Q $12,000 $11,000 $10, Q Data Source: Bureau of Economic Analysis, Annual to Q revised Dec 22, 2015

2 Exhibit 2 Annual Inflation-Adjusted Growth in U.S. Economy and Private Investment, 2010 to 2015 Inflation-adjusted growth (percent) 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% Real GDP Real private domestic investment 0.0% Q Source: U.S. Bureau of Economic Analysis. Inflation-adjusted. Dec. 22, Notes: GDP = gross domestic product. Annual rate 2010 to 2014; Q3/Q3 2014/15 annual.

3 Exhibit 3 U.S. Economic Growth Rivals or Exceeds Other High-Income Countries Real GDP growth rates, France to 2014 Japan Germany UK Canada US -2.0% 0.0% 2.0% 4.0% 6.0% 8.0% Source: World Bank database; accessed Sept Real GDP = Inflation-adjusted gross domestic product. U.S. GDP is revised.

4 Exhibit 4 U.S. Jobs Up More than 13 Million Since 2010, 5 Million Above Pre-Recession Peak Total nonfarm employment to December 2015 (millions) Source: U.S. Bureau of Labor Statistics. Seasonally adjusted. Establishment, Release 1/8/16.

5 Exhibit 5 Unemployment Rate Drops from 9.9% to 5% by 2015 U.S. unemployment rate (percent) 10% 8% 6% 4% 01/05 01/06 01/07 01/08 01/09 01/10 01/11 01/12 01/13 01/14 01/15 Source: U.S. Bureau of Labor Statistics. Monthly seasonally adjusted household to Dec Released Jan. 8, Figure generated online,

6 Exhibit 6 U.S. Private Jobs Increased by Nearly 14 Million, While Public Employment Declined Change in employment, March 2010 to December 2015 (millions) Private goods Private services -0.5 Government Total Source: U.S. Bureau of Labor Statistics. Nonfarm employment, seasonally adjusted. Released Jan 8, 2016.

7 Exhibit 7 Full-Time Jobs Account for All Net Job Growth from March 2010 to End of 2015 People employed (millions) Full time Part time, choice Part time, economic reason March 2008 March 2010 December 2014 December 2015 Source: U.S. Bureau of Labor Statistics. Household series, nonfarm employment, seasonally adjusted, Release Jan Notes: Part-time work is 34 hours or less. Part-time economic reason includes unable to find full-time work or poor business conditions.

8 Exhibit 8 Job Growth Has Been Similar for Firms of All Sizes Percent distribution of private jobs, by number of employees 100% Employees 90% 80% 70% % 50% 40% % % 10% % Source: U.S. Bureau of Labor Statistics. Business Employment Dynamics through Q Modified Nov Distribution of private sector employees by firm size.

9 Exhibit 9 Little Growth Seen in Inflation-Adjusted Average Weekly Wages, but 2015 Pace Picks Up Change in real weekly wages (percent) 4.5% 4.0% 3.5% 3.9% 3.0% 2.5% 2.0% 1.5% 1.8% 2.1% 1.0% 0.5% 0.0% Cumulative March 2010 October 2015 March 2010 October 2014 October 2014 October 2015 Source: U.S. Bureau of Labor Statistics. Real weekly earnings, seasonally adjusted for private nonfarm employment. Series uses urban consumer price index to adjust wages for inflation. Data released Nov. 17, 2015.

10 Exhibit 10 Annual Health Spending Growth Slows to Rate of GDP Growth for Four Years ( ), But Rises in 2014 Percent change (annual) NHE GDP NHE = national health expenditures. Source: Centers for Medicare and Medicaid Services, Historic and Projected National Health Expenditures. Updated July 2015.

11 Exhibit 11 Lower 10-Year CBO Medicare Projections, August 2015 vs. January 2010 Projected Medicare spending (millions) January 2010 August 2015 $1, $1,038 $1,000 $800 $600 $400 $ $852 Difference in 2020 projected Medicare spending: Cumulative difference : $186 billion $1 trillion Sources: Congressional Budget Office (CBO), The Budget and Economic Outlook: 2010 to 2020, Jan. 2010; CBO, An Update to the Budget and Economic Outlook: 2015 to 2025, updated Aug. 25, 2015.

12 Exhibit 12 Marked Slowdown in Medicare and Private Spending Growth per Enrollee Medicare Percent change in spending growth per enrollee Privately insured Source: Centers for Medicare and Medicaid Services, Office of the Actuary, Table 17, July 30, 2015, with projections.

13 Exhibit 13 Medicare Hospital Admissions for Potentially Preventable Conditions Down 25 Percent Ambulatory care sensitive hospital admissions per 1,000 beneficiaries Age 75+ ACS ages 65 to Source: Centers for Medicare and Medicaid Services, Public Use File.

14 Exhibit 14 Health Care Sector Gained 1.4 Million Jobs Since March 2010, Mainly in Ambulatory Care Ambulatory Hospital Nursing and residential March March June Jobs (millions) Source: U.S. Bureau of Labor Statistics. Seasonally adjusted establishment, June 2015 Preliminary, July 5, 2015.

15 Exhibit 15 Sharp Drop in Uninsured in All Nonelderly Age Groups Following Affordable Care Act s Insurance Expansions 18.5% % 14.3% 12.0% 7.5% 6.2% All Under 65 Under Source: U.S. Bureau of the Census, Health Insurance Coverage in the U.S.: 2014, Current Population Reports, Sept

16 Exhibit 16 What if Future Increases in U.S. National Health Expenditures Are Limited to Rate of Economic Growth? National health expenditures (trillions) $5.0 $4.5 Health spending growth, : 19.6% $42.4 trillion if same as GDP growth rate; of GDP $45.3 trillion if same as CMS projections. Cumulative difference: $2.9 trillion 17.4% of GDP $4.0 $3.5 $3.0 Based on CMS NHE projection IF NHE growth at same rate as GDP $2.5 $2.0 Actual Source: Author s analysis based on data from Centers for Medicare and Medicaid Services (CMS), Office of the Actuary, National Health Expenditures (NHE), projected July 2015; NationalHealthExpendData/NationalHealthAccountsProjected.html.

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