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After the longest government shutdown in U.S. history (one triggered by battles over health care funding) the core issue remains unresolved. Neither political party has produced a durable solution. The Centers for Medicare and Medicaid Services (CMS) projects U.S. health care spending will reach nearly $9 trillion by 2035, consuming 20 percent to 22 percent of GDP. The Congressional Budget Office projects that without significant changes in policy, total spending for health care will be 31 percent of GDP by 2035 and will increase to 46 percent by 2080.
Consequences include soaring insurance premiums and out-of-pocket costs; rising Affordable Care Act premiums; reduced federal investment in education, infrastructure, research, and defense; faster Medicare insolvency; suppressed wage growth; diminished global competitiveness; and the continued shift toward high-deductible plans. Demographic pressures (including rapid Medicare enrollment by the baby-boom generation) and high-cost drugs such as GLP-1s and gene therapies further accelerate spending.
Yet, as former White House Chief of Staff Rahm Emanuel suggests, moments of crisis also open political and civic space for ideas that once seemed impossible.