TABLE OF CONTENTS
CHAPTER 1.0:
Trends in the Overall Health Care Market
Chart 1.1:
Total National Health Expenditures, 1980 – 2010
Chart 1.2:
Percent Change in Total National Health Expenditures, 1990 – 2010
Chart 1.3:
Per Capita National Health Expenditures, 1980 – 2010
Chart 1.4:
National Health Expenditures as a Percentage of Gross Domestic Product, 1990 – 2010
Chart 1.5:
National Expenditures for Health Services and Supplies by Category, 1980 and 2010
Chart 1.6:
Percent Change in National Expenditures for Health Services
and Supplies by Category, 2009 – 2010
Chart 1.7:
Percent Change in National Expenditures for Selected Health
Services and Supplies, 2000 – 2010
Chart 1.8:
National Health Expenditures, 1980 – 2020
Chart 1.9:
Consumer Out-of-pocket Payments for National Health Expenditures, 1990 – 2010
Chart 1.10:
Total Prescription Drug Spending, 1980 – 2010
Chart 1.11:
Growth in Total Prescription Drug Spending as a Percentage of
Total Growth in National Health Expenditures, 1990 – 2010
Chart 1.12:
Consumer Out-of-pocket Spending vs. Private Health Insurance
Spending for Prescription Drugs, 1990 – 2010
Chart 1.13:
Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2010
Chart 1.14:
Distribution of Health Insurance Coverage, Percentage of
Population Covered by Payer, 1990, 2009, and 2010
Chart 1.15:
Number and Percent Uninsured, 1990 – 2010
TABLE OF CONTENTS
CHAPTER 1.0:
Trends in the Overall Health Care Market
Chart 1.16:
Average Percent Uninsured by State, 2008 – 2010
Chart 1.17:
Medicare Enrollees, 1991 – 2011
Chart 1.18:
Medicaid Enrollees, 1990, 1995, 2000 – 2011
Chart 1.19:
National CHIP Enrollment, FY 1999 – FY 2010
Chart 1.20:
Percent Change in CHIP Enrollment By State, FY 2009 – FY 2010
Chart 1.21:
Percentage of Employees with Employer-based Coverage Who Can
Choose Conventional, PPO, HMO, POS, and HDHP/SO Plans, 1988 – 2011
Chart 1.22:
Distribution of Employer-sponsored Health Insurance Enrollment
by Type of Plan, 1988 – 2011
Chart 1.23:
Percentage of Medicare Beneficiaries Enrolled in Medicare Managed Care, 1991 – 2011
Chart 1.24:
Percent Growth in Medicare Spending per Beneficiary vs. Private
Health Insurance Spending per Enrollee, 1990 – 2010
Chart 1.25:
Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care, 1992 – 2010
Chart 1.26:
Percentage of Medicaid Beneficiaries Enrolled in Medicaid Managed Care by State, 2010
Chart 1.27:
Annual Change in Health Insurance Premiums, 2000 – 2011
Chart 1.28:
Managed Care Plan Median Operating Margins, 1997 – 2011
Chart 1.29:
Operating Margins of the Top Insurers, 2009 – 2011
Chart 1.1: Total National Health Expenditures, 1980 – 2010(1)
$3,200
$2,700
Billions
$2,200
$1,700
$1,200
$700
Inf lation Adjusted (2)
$200
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(2)
Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.
Chart 1.2: Percent Change in Total National Health Expenditures,
1990 – 2010 (1)
3.9%
3.8%
6.2%
6.6%
6.8%
7.1%
8.4%
9.5%
8.5%
7.0%
6.4%
5.8%
5.6%
5.3%
5.6%
7.4%
5.6%
4.7%
5%
8.4%
10%
9.3%
Percent Change
15%
11.9%
20%
0%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.3: Per Capita National Health Expenditures, 1980 – 2010(1)
$9,200
Per Capita Amount
$8,200
$7,200
$6,200
$5,200
$4,200
$3,200
$2,200
Inflation Adjusted(2)
$1,200
$200
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(2)
Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.
17.9%
17.9%
16.8%
16.4%
16.1%
16.0%
15.9%
15.4%
13.8%
13.8%
13.7%
13.7%
13.8%
13.9%
13.7%
13.8%
13.5%
14%
13.2%
Percentage of GDP
16%
12.5%
18%
14.5%
20%
16.2%
Chart 1.4: National Health Expenditures as a Percentage of Gross
Domestic Product, 1990 – 2010(1)
12%
10%
8%
6%
4%
2%
0%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.5: National Expenditures for Health Services and Supplies(1) by
Category, 1980 and 2010(2)
$235.7B
$2,444.6B
Other,(3) 15.8%
Other, (3) 11.5%
Nursing Home Care, 6.5%
Other Medical Durables and
Non-durables, 5.9%
Prescription Drugs, 5.1%
Home Health Care, 1.0%
Other Prof essional,(4) 7.2%
Nursing Home Care, 5.9%
Other Medical Durables and
Non-durables, 3.3%
Prescription Drugs, 10.6%
Home Health Care, 2.9%
Other Prof essional, (4) 7.1%
Physician Services, 20.2%
Physician Services, 21.1%
Hospital Care, 42.6%
Hospital Care, 33.3%
1980
2010
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
Excludes medical research and medical facilities construction.
(2)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the entire time series
(back to 1960). For more information on this revision, see http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(3)
“Other” includes net cost of insurance and administration, government public health activities, and other personal health care.
(4)
“Other professional” includes dental and other non-physician professional services.
Chart 1.6: Percent Change in National Expenditures for Health Services
and Supplies(1) by Category, 2009 – 2010(2)
9%
7.2%
Percent Change
7%
6.4%
6.2%
4.9%
5%
All Health Services &
Supplies, 4.0%
2.5%
3%
2.8%
4.7%
3.2%
1.2%
1%
-1%
-3%
Home Health Admin. & Net Prescription
Care
Cost of Private
Drugs
Health
Insurance
Hospital Care
Other(3)
Physician
Services
Other
Nursing Home Other Medical
Professional (4)
Care
Durables and
Non-durables
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
Excludes medical research and medical facilities construction.
(2)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(3)
“Other” includes government public health activities and other personal health care.
(4)
“Other professional” includes dental and other non-physician professional services.
Chart 1.7: Percent Change in National Expenditures for Selected Health
Services and Supplies, 2000 – 2010(1)
25%
20%
Admin. & Net Cost of Private
Health Insurance
Percent Change
Prescription Drugs
15%
10%
Hospital Care
5%
Home Health Care
Nursing Home Care
0%
-5%
00
01
02
03
04
05
06
07
08
09
10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.8: National Health Expenditures,(1) 1980 – 2021(2)
$5,000
$4,500
$4,000
$3,500
Billions
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
80 90 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released June 2012.
(1)
Years 2011 – 2021 are projections.
(2)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.9: Consumer Out-of-pocket Payments for National Health
Expenditures, 1990 – 2010(1)
$320
$280
$240
Billions
$200
$160
$120
$80
$40
$0
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.10: Total Prescription Drug Spending, 1980 – 2010(1)
$280
$240
Billions
$200
$160
$120
$80
$40
Inflation Adjusted(2)
$0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(2)
Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for All Urban Consumers.
Chart 1.11: Growth in Total Prescription Drug Spending as a Percentage
of Total Growth in National Health Expenditures, 1990 – 2010(1)
Percentage of Total Growth
25%
20%
15%
10%
5%
0%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Billions
Chart 1.12: Consumer Out-of-pocket Spending vs. Private Health
Insurance Spending for Prescription Drugs, 1990 – 2010(1)
$120
$110
$100
$90
$80
$70
$60
$50
$40
$30
$20
$10
$0
Private Health
Insurance
Out-of -pocket
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.13: Distribution of National Health Expenditures by Source of
Payment, 1980, 2000, and 2010(1)
$255.8B
$1,377.2B
Out-of-pocket, 11.6%
Out-of-pocket, 14.7%
Out-of-pocket, 22.8%
$2,593.6B
Other Private, 5.7%
Other Private, 6.3%
Other Private, 7.9%
Private Insurance, 32.7%
Private Insurance, 33.4%
Private Insurance, 27.0%
Other Government, 13.8%
Other Government, 14.5%
Other Government, 17.5%
Total Medicaid, 16.0%
Total Medicaid, 14.8%
Total Medicaid, 10.2%
Medicare, 20.2%
Medicare, 16.3%
Medicare, 14.6%
1980
2000
2010
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
Chart 1.14: Distribution of Health Insurance Coverage, Percentage of
Population Covered by Payer, 1990, 2009, and 2010
Private
63.9%
64.0%
73.2%
13.0%
14.3%
14.5%
Medicare
9.7%
Medicaid
15.7%
15.9%
1990
2009
2010
4.0%
4.1%
4.2%
Other Government
13.9%
16.7%
16.3%
Uninsured
0%
10%
20%
30%
40%
50%
60%
70%
80%
Source: US Census Bureau, Current Population Survey, 2011 Annual and Social Economic Supplement. Data released February 2011.
Table HIB-4. Health Insurance Coverage Status and Type of Coverage by State All People: 1999 to 2010.
Link: http://www.census.gov/hhes/www/hlthins/data/historical/files/hihistt4B.xls.
Chart 1.15: Number and Percent Uninsured, 1990 – 2010
Number
Percent
Number of Uninsured (Millions)
50
18%
16%
45
14%
40
12%
35
30
10%
25
8%
20
6%
15
4%
10
Percent of Total Population
55
2%
5
0
0%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2010. Data released August
2011. Table 8. People Without Health Insurance Coverage by Selected Characteristics: 2009 and 2010.
Link: http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/table8.pdf.
Chart 1.16: Average Percent Uninsured by State, 2008 – 2010
RI 11.5%
DE 11.7%
DC 11.4%
< 10.0%
10.0% - 14.9%
15.0% - 19.9%
 20.0%
Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2010. Data released August
2011. Link: http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/state.xls.
46.6
47.7
48.7
38.8
39.7
40.1
45.5
38.4
39.1
44.4
38.1
43.4
37.5
42.6
36.9
41.9
36.3
41.2
35.6
40.5
34.9
Chart 1.17: Medicare Enrollees,(1) 1991 – 2011
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
10
11
50
45
40
35
Millions
30
25
20
15
10
5
0
Source: Centers for Medicare & Medicaid Services. Medicare Enrollment: National Trends, 1966 – 2005; Medicare Aged and
Disabled Enrollees by Type of Coverage. CMS, Office of the Actuary. Email correspondence with CMS staff (for years 2001 – 2011).
(1)
Hospital insurance (Part A) enrollees and/or Supplementary Medical Insurance (Part B) enrollees; includes all persons (aged and
disabled).
Chart 1.18: Medicaid Enrollees,(1) 1990, 1995, 2000 – 2011
80
67.8
70
57.3
60
48.4
Millions
50
60.9
60.5
69.5 Other Title XIX
62.1
Adults
52.4
44.5
36.3
40
30
50.9
58.6
67.7
25.3
Children
20
Blind/Disabled
10
Aged
0
1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: Congressional Budget Office. Data released February 2011. Spending and Enrollment Detail for CBO’s
March 2011 Baseline: Medicaid. Link: http://www.cbo.gov/budget/factsheets/2011b/medicaid.pdf.
(1)
Does not include CHIP Enrollees.
Chart 1.19: National CHIP Enrollment,(1, 2) FY 1999 – FY 2010
7,695,264 7,705,723
6,745,194
5,984,772
7,097,584
7,355,746
6,102,784 6,151,215
5,353,812
4,622,204
3,333,879
1,959,330
FY 1999 FY 2000
FY 2001
FY 2002
FY 2003
FY 2004
FY 2005
FY 2006
FY 2007
FY 2008
FY 2009
Source: Centers for Medicare & Medicaid Services. Data released February 2011. Number of Children Ever Enrolled
by Program Type. Link: http://www.cms.hhs.gov/NationalCHIPPolicy/downloads/CHIPEverEnrolledYearGraph.pdf.
(1)
Number of children enrolled at any point in the year.
(2)
2009 figure reflects revised data released by Centers for Medicare & Medicaid Services on February 1, 2011.
FY 2010
Chart 1.20: Percent Change in CHIP Enrollment by State,
FY 2009 – FY 2010(1)
RI 19%
DE 2%
DC -13%
<0%
1% - 9%
10% - 19%
20% - 29%
 30%
Source: Centers for Medicare & Medicaid Services. Data released February 2011. Number of Children Ever Enrolled
by Program Type. Link: http://www.cms.gov/NationalCHIPPolicy/downloads/FY2010StateCHIPTotalTable_020111_FINAL.pdf.
(1)
2009 figure reflects revised data released by Centers for Medicare & Medicaid Services on February 1, 2011.
Chart 1.21: Percentage of Employees with Employer-based Coverage
Who Can Choose Conventional, PPO, HMO, POS, and HDHP/SO Plans,
1988 – 2011
100%
Conventional
(1)
(2)
PPO
HMO
POS
2005
2006
2007
HDHP/SO
(3)
80%
60%
40%
20%
0%
1988
1996
1999
2002
2008
2009
2010
Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2011. Employer
Health Benefits: 1999, 2002, 2005, 2006, 2007, 2008, 2009, 2010, 2011. Link: http://ehbs.kff.org/pdf/2011/8225.pdf.
KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1996.
(1)
Conventional plans refer to traditional indemnity plans.
(2)
Point-of-service plans not separately identified in 1988.
(3)
In 2006, the survey began asking about HDHP/SO, high deductible health plans with a savings option.
2011
Chart 1.22: Distribution of Employer-sponsored Health Insurance
Enrollment by Type of Plan, 1988 – 2011
100%
HDHP/SO
POS
80%
(3)
(2)
HMO
60%
40%
PPO
20%
Conventional
0%
1988
1996
1999
2002
2005
2006
2007
2008
2009
2010
Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2011. Employer
Health Benefits: 1999, 2002, 2005, 2006, 2007, 2008, 2009, 2010, 2011. Link: http://ehbs.kff.org/pdf/2011/8225.pdf.
KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1996.
(1)
Conventional plans refer to traditional indemnity plans.
(2)
Point-of-service plans not separately identified in 1988.
(3)
In 2006, the survey began asking about HDHP/SO, high deductible health plans with a savings option.
2011
(1)
5%
6%
4%
8%
9%
6%
12%
17%
25%
25%
22%
13%
12%
12%
17%
17%
15%
13%
10%
15%
13%
18%
16%
21%
4%
Percentage of Beneficiaries
24%
20%
27%
24%
Chart 1.23: Percentage of Medicare Beneficiaries Enrolled in Medicare
Managed Care,1991 – 2011
3%
0%
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Email correspondence with CMS staff in January 2012.
Chart 1.24: Percent Growth in Medicare Spending per Beneficiary vs.
Private Health Insurance Spending per Enrollee, 1990 – 2010(1,2)
20%
18%
16%
14%
12%
10%
Private Health
Insurance
8%
6%
4%
2%
Medicare
0%
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 9, 2012.
(1)
CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are
applied to the entire time series (back to 1960). For more information on this revision, see
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf.
(2)
Data reflects spending on benefits commonly covered by Medicare and Private Health Insurance.
07
08
09
10
Chart 1.25: Percentage of Medicaid Beneficiaries Enrolled in Medicaid
Managed Care, 1992 – 2010
80%
71% 72% 71%
Percentage of Beneficiaries
70%
57% 58% 59%
54% 56% 56%
60%
65% 64%
48%
50%
40%
40%
29%
30%
20%
61% 63%
23%
12% 14%
10%
0%
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment Report as of
June 30, 2010.
09
10
Chart 1.26: Percentage of Medicaid Beneficiaries Enrolled in Medicaid
Managed Care by State, 2010
RI
DE
DC
67.4%
77.4%
69.7%
0%
1% - 24%
25% - 49%
50% - 74%
75% - 100%
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Medicaid Managed Care Enrollment Report
as of June 30, 2010.
Chart 1.27: Annual Change in Health Insurance Premiums, 2000 – 2011
16%
Annual Percent Change
13.3% 13.3%
12%
11.2%
9.7%
9.7%
9.5%
9.4%
8%
5.5%
5.5%
4.7%
5.5%
4%
3.0%
0%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Source: The Kaiser Family Foundation and Health Research and Educational Trust. Data Released 2011.
Link: http://ehbs.kff.org/pdf/2011/8225.pdf.
2010
2011
Chart 1.28: Managed Care Plan Median Operating Margins,(1)
1997 – 2011
10%
Median Operating Margins
9%
7.8%
8%
6.9%
7%
6%
5%
4%
5.8%
4.9%
4.9%
7.1%
7.5%
6.6%
6.3% 6.5%
5.6%
5.0%
4.4%
3.8% 3.9%
3%
2%
1%
0%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: Company documents of publicly traded managed care plans.
(1)
Represents earnings before interest and taxes over net revenues for the total service lines of the11 largest publicly
traded managed care plans.
Chart 1.29: Operating Margins of the Top Insurers, 2009 – 2011
2009
2010
2011
14%
Operating Margin
12%
10%
8%
6%
4%
2%
0%
Aetna
WellPoint
UnitedHealth
Group
Source: FactSet Research Systems Inc. Data for all years updated as of March 2012.
Data from Hoovers used in 2011 and earlier years’ Chartbooks.
Cigna
Humana