• Book

The Nation's Health Care Bill: Who Bears the Burden?


Cromwell, J., Healy, D., Seeley, E., Trebino, D., & Cromwell, G. (2013). The Nation's Health Care Bill: Who Bears the Burden?. RTI Press Publication No. BK-0010-1307. Research Triangle Park, NC: RTI Press.


Health care spending has increased dramatically in the past 50 years and now accounts for nearly one out of every five dollars spent in the United States. This chartbook informs citizens and policy makers about the rapidly growing financial burden of health care spending borne by households, private businesses, and state and local governments. It includes 39 charts with accompanying tables and text and reveals the hidden costs of a rising share of resources in the US devoted to health services. The Nation’s Health Care Bill: Who Bears the Burden? establishes a baseline to monitor changes in the health care financial burden that result from passage of the Patient Protection and Affordable Care Act (ACA) by Congress in 2010.

Author Details

Jerry Cromwell

Jerry Cromwell, PhD, has more than 35 years of experience conducting federally funded technical and evaluation projects in health economics. Major fields include Medicare hospital and physician payment systems and productivity gains, disease management evaluations, federal-state Medicaid public finance, physician participation in publicly funded health programs, reimbursement of anesthesia services, and disparities in access to complex health technologies. His technical expertise includes actuarial estimation of hospital inpatient and outpatient payment rates, quasi-experimental design of payment reform demonstrations, quantification of breadth and depth of state Medicaid insurance coverage and physician work effort, and econometric analysis of business cycle effects on Medicaid eligibility. He has sat on AHCPR, VA, and OTA health care study sections and testified before Congress on Medicare and Medicaid payment reforms. He is the founder and past president of Health Economics Research, which was acquired by RTI in 2002.

Deborah Healy

Deborah Healy, PhD, University of Chicago, is a senior economist specializing in antitrust and health care at Compass Lexecon in Chicago.

Elizabeth Seeley

Elizabeth Seeley, PhD, London School of Economics, is a research consultant and lecturer at the Harvard School of Public Health with a concentration in pharmaceutical reimbursement policy.

Diana Trebino

Diana Trebino, MPH in health policy and management, Boston University, is an RTI research associate based in RTI’s Waltham, Massachusetts, office.

Genevieve Cromwell

Genevieve Cromwell

Genevieve Cromwell, BA in economics, Ohio Wesleyan University, is also an RTI research associate based in RTI’s Waltham, Massachusetts, office.