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Mitch McConnell just hinted Republicans could take another crack at repealing Obamacare if the midterms go his way

Mitch McConnell just hinted Republicans could take another crack at repealing Obamacare if the midterms go his way

President Barack Obama and then-Senate Minority Leader Mitch McConnell

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President Barack Obama and then-Senate Minority Leader Mitch McConnell
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Chip Somodevilla/Getty Images
  • Senate Majority Leader Mitch McConnell said the GOP would take another shot at repealing Obamacare if the party kept control of Congress this fall.
  • McConnell called the failure to repeal Obamacare “the one disappointment of this Congress from a Republican point of view.”
  • Democrats are hammering Republicans on healthcare in the lead up to the midterms, as the GOP’s repeal and replace plans proved unpopular.

Senate Majority Leader Mitch McConnell wants another shot at repealing the Affordable Care Act, the law better known as Obamacare.

“If we had the votes to completely start over, we’d do it,” McConnell told Reuters in an interview Wednesday. “But that depends on what happens in a couple weeks … we’re not satisfied with the way Obamacare is working.”

The GOP attempted to repeal and replace Obamacare in 2017 but were unable to do so despite holding majorities in each chamber of Congress. The party faced major roadblocks as Obamacare became more popular and each iteration of their replacement bill was greeted with distaste from the public. Their attempts eventually failed when the late Sen. John McCain signaled his vote against the repeal bill with his dramatic thumbs down.

In the interview, McConnell called the failed repeal bid “the one disappointment of this Congress from a Republican point of view.”

Despite the swing and miss, the GOP and the Trump administration have been able to leave their stamp on the ACA. The Department of Health and Human Services has allowed states to apply for waivers to make major changes to their Medicaid programs that could result in fewer people being covered and slashed the funding for Obamacare outreach.

For their part, congressional Republicans were able to repeal Obamacare’s individual mandate – the requirement that all people must have health insurance or be faced with a penalty – as part of the GOP tax law.

Senate Minority Leader Chuck Schumer quickly jumped on the comment, pointing to it as proof that the GOP wanted to gut various ACA protections, like safeguards for people with preexisting conditions.

“Americans should make no mistake about it: if Republicans retain the Senate they will do everything they can to take away families’ health care and raise their costs,” Schumer said in a statement. “Whether it be eliminating protections for pre-existing conditions, repealing the health care law, or cutting Medicare and Medicaid. Americans should take Senator McConnell at his word.”

Democrats have hammered Republicans in the run up to the midterm elections, attacking their votes on Obamacare repeal and replace bills that would have weakened preexisting condition protections.

As it stands, McConnell may not get his chance at another repeal shot. While Republicans are forecast to hold the Senate, Democrats are heavily favorite to regain control of the House.

Spending on insurance plans has increased nearly 50% in the last 10 years, as healthcare costs in the US continue to skyrocket

Spending on insurance plans has increased nearly 50% in the last 10 years, as healthcare costs in the US continue to skyrocket

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David Hilowitz
  • The US total healthcare spending has increased, and the trend is expected to continue.
  • A new study showed that spending on health services for those with employer-sponsored insurance plans increased by 44% over the past decade.
  • Brand-name prescriptions, emergency department visits, and outpatient surgery were the categories that accounted for the greatest proportion of spending increases.

The US is spending more on healthcare than ever before.

A new study published in Health Affairs on Wednesday found that total spending on health services, excluding premiums, for those with employer-sponsored insurance plans increased by 44% from 2007 to 2016.

Researchers found that spending increased across all major categories of health services, although the amount each category increased by varied. The costs of services rising also plays a role in the increase in total spending.

The study was done by using a national sample of 40 million health care claims data from the Health Care Cost Institute, and included contribution from insurers Aetna, Humana, Kaiser Permanente, and UnitedHealthcare.

About half of the US population is covered under employer-sponsored insurance, according to Niall Brennan, president of Health Care Cost Institute. This survey captures about a quarter of that population.

Enrollment in high deductible health plans grew from 5% in 2007 to 29% in 2016. Overall, Brennan estimates that overall insurance coverage has gone up for people both with and without employer-sponsored insurance.

Brand-name prescriptions, emergency department visits, and outpatient surgery accounted for nearly half of the spending increase. Out of pocket spending rose 43%, attributed to emergency department visits. Brennan said outpatient surgeries are increasing because they tend to be a substitution for hospitalization. Hospital outpatient service spending (including non-overnight care and surgeries) increased more rapidly than other types of services. Prescription drug spending is driven by the introduction of new and innovative drugs, but also the persistent increase across all types of drugs.

Brennan said this trend feeds into the key issue of unconstrained growth in healthcare spending. With the increasing amounts of mergers and acquisitions in the healthcare space, hospitals are taking over other hospitals and private practices. With this, insurance agreements and service charges change so patients can end up paying more for the same services from the same doctors in a large hospital system than they did in a private practice.

Competitive dynamics between hospitals can also make it harder for insurers to negotiate down prices.

This trend is forecast by the Center for Medicare and Medicaid Services to continue. Right now, healthcare spending accounts for about 17.5% of the GDP. In the next 8-10 years, it’s predicted to rise to 19.2%.

See also:

CARL ICAHN: The $67 billion Cigna-Express Scripts merger may ‘rival the worst acquisitions in corporate history’

CARL ICAHN: The $67 billion Cigna-Express Scripts merger may ‘rival the worst acquisitions in corporate history’

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REUTERS/Brendan McDermid
  • The billionaire investor Carl Icahn is not a fan of Cigna’s plan to purchase the pharmacy benefit manager Express Scripts, a $67 billion deal that was announced in March.
  • In a letter to Cigna stockholders sent Tuesday, Icahn said the deal “may well rival the worst acquisitions in corporate history.”
  • Icahn cited regulatory challenges facing the PBM model as well as competitive risk from Amazon.

Carl Icahn doesn’t want the health insurer Cigna’s $67 billion deal with Express Scripts.

Icahn, who recently took a stake in Cigna, wrote in a letter to Cigna shareholders Tuesday that the deal “may well rival the worst acquisitions in corporate history.” Icahn disclosed that he was also short Express Scripts.

Cigna, one of the US largest health insurers, announced the deal in March, offering $48.75 a share in cash for Express Scripts in a move aimed to cut soaring healthcare costs. The $54 billion price tag was a 31% premium to Express Scripts’ stock price at the time and includes about $15 billion worth of Express Scripts’ debt.

In his letter, Icahn highlighted regulatory challenges facing the pharmacy-benefit-manager business that Express Scripts is in. Drug companies and the Trump administration have been calling for the end of the rebate, which is negotiated through middlemen like Express Scripts and passed along to health plans as a way to discount the price of a prescription drug.

Icahn also noted the threat posed by companies like Amazon, which has gotten more involved in healthcare this year, calling it an “existential threat” to PBMs like Express Scripts.

“Purchasing Express Scripts may well become one of the worst blunders in corporate history, ranking up there with the Time Warner/AOL fiasco and General Electric’s long-running string of value destruction,” Icahn said in the letter.

Instead, Icahn argued, Cigna would be better off partnering with PBMs like Express Scripts so the health insurer could develop or acquire a PBM when it’s clear what is best suited for the changing healthcare business.

In April, the Department of Justice asked for an extension to gather more information from Cigna and Express Scripts. The 30-day waiting period needed for the deal to close will not begin until all the information has been obtained, and that process can take a while. Cigna’s shareholders are set to vote on August 24 on the deal.

Here’s the full letter:

WHY CIGNA’S INVESTMENT IN EXPRESS SCRIPTS MAY WELL RIVAL THE WORST ACQUISITIONS IN CORPORATE HISTORY

When Cigna entered into this agreement several months ago I believed a $60 billion purchase price made no sense, but there were at least arguments that could be made by management to try to persuade us into thinking that it was not completely ridiculous. These arguments now disappear in light of certain material events of the last month, such as Amazon’s almost certain entrance as a competitor to Express Scripts and the government’s direct challenge to the highly flawed rebate system. As a result, Express Scripts’ earnings will almost certainly be seriously diminished, but even more importantly, Express Scripts will be existentially challenged, i.e., their very existence might well come into question over the next few years. Even if they do survive, exposing Cigna, a thriving company, to these risks by acquiring Express Scripts now is inexplicably ridiculous. Purchasing Express Scripts may well become one of the worst blunders in corporate history, ranking up there with the Time Warner/AOL fiasco and General Electric’s long-running string of value destruction.

It is imperative that every Cigna shareholder vote against this transaction. Today there is only one possible reason that certain Cigna shareholders might vote to purchase Express Scripts – because they want to see it saved and are willing to sacrifice the value of their investment in Cigna to achieve this end.

Cigna is, in my opinion, undervalued because of the fear that this transaction may be approved by shareholders. It is patently ridiculous to pay $60 billion for a company with the problems Express Scripts now faces. I rarely discuss my current market activity but, for the sake of full disclosure, I am currently long Cigna and short Express Scripts stock. I have made this investment because I believe in the rationality of Cigna’s investors. I also hope and believe that many of the Cigna investors that had also owned Express Scripts have already sold much of their Express Scripts stock knowing the pitfalls that company faces if Cigna does not save them.

I believe that Cigna’s management, whose operating skill I respect, would never have paid anywhere near $60 billion for Express Scripts if they had known about the recent events of the last months. Before these events, Cigna had a definitive agreement with Express Scripts stating that the board would support this transaction or pay to Express Scripts a “break-up fee” of $1.6 billion. The only way to end this terrible transaction and not pay the “break-up” fee is for shareholders to vote down the purchase.

We believe that the proposed Express Scripts acquisition exposes the Cigna shareholders to a number of significant risks that management and the board have chosen to recklessly disregard. It is also important to note that these risks have dramatically worsened since the deal was announced.

Regulatory risk – the current administration is particularly focused on bringing down prescription drug prices for consumers and has specifically targeted PBMs as the part of the supply chain that is overearning relative to the value they produce. There is a strongly held belief that the rebate system, which Express Scripts relies on heavily, is a rigged game with conflicting incentives that might actually be pushing up drug prices. The recent proposed rule to remove the safe harbor protection for rebate payments is a clear shot across the bow for the PBM industry and occurred after the signing of the Cigna/Express Scripts merger agreement.

Alex Azar, HHS Secretary, said on May 11th: “The evidence suggests that many companies in the supply chain may actually contribute to, or even encourage, high drug prices, drug price increases and rising consumer costs.” “Some stakeholders-particularly PBMs-suggest that rebates and discounts lower the cost of drugs for Medicare beneficiaries because these concessions drive down the price paid for a medication. However, rebate arrangements may allow PBMs and plan sponsors to benefit from high list prices if rebates are based on a drug’s WAC. To this point, manufacturers contend that rebates encourage them to set higher list prices to account for price concessions down the road.”

We believe this is the start of a concentrated effort to reform drug pricing and eliminate the highly flawed rebate system. Obviously, neither we nor Cigna can know where the ultimate legislation may end up, but the recent moves by the Trump administration have raised the risk level and, by definition, further impaired the value of Express Scripts since the deal was announced. It is our belief that the PBM industry will move to an entirely fee-based model over time, which already exists for some customer groups. Since rebate customers are among the highest margin for PBMs, this shift is very likely to result in significant margin compression.

Analysts Ross Muken and Michael Newshel of ISI Evercore commented – “HHS appears to be following through with its threat to disrupt the drug rebate system – and faster than we had expected….the scope and details are unknown at this point, but the heightened risk and uncertainty should renew pressure on shares of PBMs, distributors and pharmacies, whose economics are driven off of gross price”

Competitive Disruption – the PBM model is ripe for disruption from large scale competitors who may seek to cut them out of the supply chain and lower consumer prices. During the weeks leading up to the deal (when Cigna was busy bidding against itself), Amazon, Berkshire Hathaway and JP Morgan formed a partnership to create a lower cost, more efficient technology-enabled healthcare solution for their employees and eventually 3rd parties as well. With the scale and size of their potential future constituent populations, there is little reason to believe they wouldn’t seek a significant amount of savings from the sourcing of prescription drugs. Although their full plans are not clear yet, this development further increases the risk to the economics of the PBM business model. Even after this announcement, Cigna management seemed unconcerned and repeatedly raised their bid for Express Scripts. To make matters worse, it is important to note that after the acquisition of Express Scripts was disclosed, Amazon announced its acquisition of online pharmacy PillPack which will immediately put it in competition with Express Scripts’ mail order pharmacy business. With their 100 million prime members, Amazon has become one of the toughest competitors in history (feel free to ask the retail industry), while their ultimate healthcare plans are not revealed yet, it is almost certain the first step of a much larger play in the pharma distribution space. Make no mistake, Express Scripts is no Apple and breaking into the PBM ecosystem is not that difficult for a company that already has the systems, the network and the scale that Amazon does. Knowing this, it is absurd for Cigna to now walk into the minefield that Express Scripts might well become.

Post-Anthem margins and customer retention – It’s well documented that Express Scripts will be losing Anthem as a 30% customer in 2020, one which they were clearly overearning on. Management has attempted to quantify the profit impact and pro-forma post-Anthem margins, but we are skeptical that anyone can accurately forecast the impact of losing such a large customer. In addition to the loss of revenues and profits, there are likely to be significant stranded costs and unabsorbed overhead that will have to be addressed over time. Additionally, Express will go from being the 2nd largest PBM by number of scripts to the 4th largest. It’s impossible to forecast what effect this loss of scale will have. Furthermore, Express Scripts most likely gets some benefit from being the last big independent PBM. We see it as likely that, over time, Express Scripts’ customer retention will decline from current levels, particularly as its soon-to-be larger competitors further strengthen and expand their captive PBM offerings. Additionally, if Express Scripts is part of Cigna, a number of customers that Express Scripts now has might well not be willing to deal with a company that is owned by one of their competitors.

Ross Muken from ISI Evercore echoed similar thoughts shortly after the deal announcement – “ESRX’s income primarily comes from mail order pharmacy, which is secularly challenged, and specialty pharmacy, which is increasingly competitive and likely to see gross margin degradation. Further, the two other large PBM competitors have described target PBM margins of 3-5%, so it seems that ESRX’s current core EBIT margins near 6% may be unsustainable”

Deal Price – Each of these risks is significant enough on its own to seriously impair the business and ultimately the value of Express Scripts to the Cigna shareholder. Put together, we cannot fathom how Cigna’s management and board saw fit to pay an all-time high price for Express Scripts with so many unknown risks lying dead ahead. This amounts to nothing more than a huge bail-out for the Express Scripts shareholders at the expense of Cigna’s. The fact that Cigna offered a 30% premium for Express after a 30% run up in the share price indicates Cigna management’s desperation to do a large deal at any price after being blamed for not being willing to fight for the Anthem deal. According to the proxy, amazingly Cigna repeatedly raised their offer against no competition for Express Scripts until, ultimately, they were paying a 60% premium versus where the stock was only 3 months prior. To believe that they can create significant value above this price to the Cigna shareholder is the height of arrogance in my opinion. The modest amount of synergies that flow to the bottom line benefit of the Cigna shareholders do not nearly compensate for the risks we are taking on or the inevitable multiple contraction of the combined company. We do not accept the comparison of the United Health/Optum multiple as a reliable justification for this deal. Optum is only 20% of United Health’s total profits, has much lower external customer mix and does not rely on rebates and mail order nearly as much. It is our opinion that the combined company will likely trade poorly for a prolonged period due to both the challenge and disruption of integrating two large companies and as the threats mentioned above continue to worsen.

Cigna and Express Scripts Standalone Value – As mentioned above we believe that Express Scripts is a company with major problems whose business could well fall off a cliff. Given the significant worsening of several major risks since the deal announcement, we are confident in saying that Express Scripts on a standalone basis would likely be worth less than $60. Though there is a not another standalone PBM to compare Express Scripts to, we note that drug distributors McKesson and Amerisource Bergen are down 17% and 16% respectively since the announcement of the Cigna/Express Scripts deal and that the risks are likely greater in the case of Express Scripts. Applying the 9x P/E multiple that pharmacies and drug distributors currently trade at to Express Scripts’ 2019E ex-Anthem earnings of $6.50 would result in a $58.50 standalone stock price. We find it unconscionable to pay over $90 for a company that today would likely be worth less than $60.

We believe that completing this merger will result in much lower value for the Cigna shareholder than continuing standalone and investing in its own business and PBM capabilities. Since March 7th, the day before the deal was announced to July 31st, Cigna’s stock price is down 7.6% while its non-deal competitors (United Health, Anthem and Humana) are up an average of almost 12% for a total underperformance of almost 20%. If Cigna had simply performed in-line with it comp group, the stock would likely be $215 per share. We believe that if Cigna shareholders vote down the deal and the cash merger consideration and free cash flow were used to repurchase shares, the stock could be worth up to $250 in a reasonable time frame.

We strongly disagree with the idea that Cigna’s only route to offering a more integrated solution is to make a $60 billion leveraged bet on a company with as many challenges as Express Scripts. For example, Anthem formed a five-year partnership with CVS/Caremark to offer a full suite of PBM services while Anthem builds up their own PBM offering, IngenioRx. According to the merger proxy, Cigna and Express Scripts did start discussing a close partnership with a white-label solution. We fail to see how this wouldn’t be a logical first step in increasing the breadth and depth of Cigna’s PBM capabilities at much lower risk, especially while the regulatory and competitive landscapes are in flux. We suspect this option was quickly disregarded because it didn’t serve management’s sub rosa goal of running a much larger company.

The existential threats to the PBM business model over the next few years are undeniable and largely can’t be analyzed with any certainty. Both the pharmaceutical rebate and mail order pharmacy businesses are facing regulatory and competitive challenges that could change both forever. Despite this, Cigna management is offering to pay an all-time high price for a company that, as a result of secular changes, is currently standing on very dangerous ground.

For these reasons, among others, your vote at the special meeting of Cigna shareholders called to consider and act on the Merger Agreement Proposal (as defined in our proxy statement) is very important to the future success of your investment in Cigna. I hope you will join with us in opposing this transaction for the reasons set forth above.

Sincerely yours,

Carl C. Icahn

The former CEO of GE pinpoints the moment he realized healthcare was his problem

The former CEO of GE pinpoints the moment he realized healthcare was his problem

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Chip Somodevilla/Getty Images
  • Jeff Immelt, the former CEO of General Electric, can pinpoint the day he understood that employee healthcare was his problem.
  • Large employers like GE are on the hook for the healthcare expenses of their employees.
  • In 2009, Immelt realized GE was spending $3 billion annually on employee healthcare, which was more than the company’s healthcare unit was even earning.
  • “If you employ a workforce and offer benefits, your business IS a healthcare business,” Immelt wrote on LinkedIn.

Jeff Immelt’s employee healthcare problem began in 2009.

Immelt, then the CEO of General Electric, learned that his company had spent $3 billion annually on healthcare for employees. That was more than the company’s healthcare unit was making, and was more than the company had spent on steel.

“The day I had that realization was the day that employee healthcare became my problem, and solving it became my mission,” Immelt wrote on LinkedIn on July 26.

For many Americans, their employers are the ones picking up the tab. More than half of the non-elderly population is covered by an employer-sponsored plan, and almost 80% of large companies are self-insured . As healthcare costs go up, employers are the ones feeling the pressure. And some are starting to get fed up.

And, as Immelt noted, national health expenditure grew by at least 5% in the 2000s.

But as healthcare costs have gone up, employers are the ones feeling the pressure. And some are starting to get fed up, prompting some of America’s biggest companies including Berkshire Hathaway, Amazon, and JPMorgan to start to do something about it.

So Immelt worked on ways to get a better hold on how much the company was spending on healthcare and why. The company set up different metrics and made it a higher priority for its executive team. it started to talk about employee healthcare on a quarterly basis rather than once a year.

“Our benefits program went from being a mess of irrelevant metrics to having a simple formula for success-dollars spent per employee vs. employee absenteeism,” Immelt said. By the end, Immelt said, the company reduced healthcare costs by 20%.

Beyond his work at GE, Immelt currently serves as the chairman of health IT company Athenahealth, and said in the Linkedin post that he’s joining the board of Collective Health, a startup that helps employers build out health plans that fit their needs by adding technology with the hope of making tasks ike submitting claims and reading bills easier.

Immelt seemed optimistic that employers and their leadership can take on the rising cost of healthcare.

“If Jeff Bezos, Warren Buffett, and Jamie Dimon have made one thing clear, it’s that CEOs can tackle the thorny issue of healthcare,” Immelt wrote.

“Because, if you employ a workforce and offer benefits, your business IS a healthcare business.”

See also:

The 35 most expensive reasons you might have to visit a hospital in the US — and how much it costs if you do

The 35 most expensive reasons you might have to visit a hospital in the US — and how much it costs if you do

  • Hospital stays are expensive – adding up to more than $384.5 billion a year in the US, according to recent data.
  • The average hospital stay costs over $10,000, but the amount varies widely depending on the medical condition.
  • The top 35 most expensive conditions account for more than 70% of all hospital costs in the US.

Any hospital visit can be scary – and frighteningly expensive.

The average hospital stay in the US costs just over $10,700, based on an analysis of recent data from the Healthcare Cost and Utilization Project (HCUP).

Using the 2014 National Impatient Survey from the Agency for Healthcare Research and Quality, HCUP found the hospital visits and costs associated with different medical conditions classified by the Clinical Classifications Software principal diagnosis category. In total, there were 35.4 million hospital stays with an aggregate cost of $384.5 billion.

Routine childbirth accounted for the most stays – over 3.8 million – but is a relatively low-cost hospital trip compared to other conditions at $3,600. Of all hospital stays billed to Medicaid, 23.1% fell in this category.

The 35 most expensive conditions accounted for 70% of all hospital costs in the US. Septicemia – also called sepsis, a life-threatening reaction to an infection – created the greatest total cost at $27 billion. But, because of the large number of patients treated for the condition, it did not have the highest average cost per treatment. Heart and lung conditions also show up frequently when looking at the most expensive illnesses.

Who paid the hospital bill tells a different story, and is an important piece of the national debate on health care. Medicare covered 46% of that cost, with Medicaid pitching in 17%. Private insurance paid for 28% of the cost, while 5% went to patients who were uninsured.

In addition to what patients are going to the hospital for, where they are can also affect costs. A trip to the hospital in the US can vary a great deal based on where you live.

We went through the 50 conditions with the highest total hospital cost and found the average cost per hospital stay based on how many visits were made for each condition. These are the 35 conditions with the highest average cost:


35. Pancreatic disorders

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Steve Jobs died of pancreatic cancer.
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Justin Sullivan/Getty Images

Acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer are several of the more common disorders that lead to digestive problems in the pancreas.

Average cost per stay: $9,727

Percent of all US hospital stays: 0.9%


34. Pneumonia

Pneumonia is a lung condition – an infectious inflammation of the air sacs.

Average cost per stay: $9,793

Percent of all US hospital stays: 2.5%


33. Diabetes mellitus with complications

Conditions that occur from poor treatment of diabetes are wide-ranging, from vascular diseases, blindness, and chronic kidney disease.

Average cost per stay: $9,850

Percent of all US hospital stays: 1.5%


32. Diverticulosis and diverticulitis

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China Photos/Getty

Diverticulosis is the presence of bulging pouches in the digestive track and diverticulitis occurs when the pouches become inflamed or infected.

Average cost per stay: $10,169

Percent of all US hospital stays: 0.8%


31. Cardiac dysrhythmias

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Wikimedia Commons

Cardiac dysrhythmia is the medical term for an irregular heartbeat.

Average cost per stay: $10,191

Percent of all US hospital stays: 1.9%


30. Intestinal obstruction without hernia

Intestinal obstruction is a food or liquid blockage that may be caused by Crohn’s Disease, colon cancer, or other diseases.

Average cost per stay: $10,944

Percent of all US hospital stays: 1.0%


29. Congestive heart failure

Congestive heat failure is the inability to pump an adequate amount of blood through the body and can be caused by many diseases.

Average cost per stay: $11,500

Percent of all US hospital stays: 2.5%


28 . Other nervous system disorders

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Courtesy of The University Of Louisville

Trauma, infections, and tumors are some of the many conditions that afflict the brain, spine, nerves, eyes, ears, or other parts of the nervous system.

Average cost per stay: $11,538

Percent of all US hospital stays: 0.7%


27. Other gastrointestinal disorders

Food allergies, lactose intolerance, and celiac disease are some of the many disorders that harm functionality of the stomach and intestines.

Average cost per stay: $11,564

Percent of all US hospital stays: 0.6%


26. Pulmonary heart disease

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Joe Raedle/Getty

A high blood pressure that affects lung arteries and the right side of your heart results in pulmonary hypertension.

Average cost per stay: $11,564

Percent of all US hospital stays: 0.5%


25. Biliary tract disease

Biliary diseases are a group of conditions that affect the biliary system – including gallstones and pancreatitis.

Average cost per stay: $11,764

Percent of all US hospital stays: 1.1%


24. Hypertension with complications and secondary hypertension

Unlike pulmonary hypertension (heart disease), secondary hypertension is high blood pressure caused by another medical condition.

Average cost per stay: $12,164

Percent of all US hospital stays: 0.7%


23. Other nutritional, endocrine, and metabolic disorders

Osteoporosis, cystic fibrosis, and obesity are major diseases related to glands and metabolism.

Average cost per stay: $12,173

Percent of all US hospital stays: 0.6%


22. Complications of surgical procedures or medical care

source
Reuters

Any side effect of surgery or a basic medical procedure is included here.

Average cost per stay: $13,565

Percent of all US hospital stays: 1.3%


21. Rehabilitation care, fitting of prostheses, and adjustment of devices

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Justin Sullivan/Getty Images

Rehabilitation includes “services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled.”

Average cost per stay: $13,877

Percent of all US hospital stays: 1.1%


20. Other fractures

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Flickr / Sandor Weisz

This category includes broken bones that are not in their own category such as skull breaks.

Average cost per stay: $14,149

Percent of all US hospital stays: 0.6%


19. Abdominal hernia

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Christopher Furlong/Getty

A hernia is the protrusion of an organ through tissue and often occurs by the pelvic floor or abdominal wall.

Average cost per stay: $14,447

Percent of all US hospital stays: 0.5%


18. Acute cerebrovascular disease

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Justin Sullivan/Getty Images

Cerebrovascular disease impacts the blood flow in the brain and often results in strokes.

Average cost per stay: $15,378

Percent of all US hospital stays: 1.7%


17. Osteoarthritis

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Denis Balibouse/Reuters

Osteoarthritis – or degenerative joint disease – is the wearing down of tissue between joints.

Average cost per stay: $15,897

Percent of all US hospital stays: 3.0%


16. Maintenance chemotherapy, radiotherapy

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Chris Hondros/Getty Images

Chemo and radiation therapy are both types of cancer treatment.

Average cost per stay: $15,988

Percent of all US hospital stays: 0.4%


15. Fracture of neck of femur (hip)

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Grandpa / Shutterstock.com

Breaks in the neck of the femur are common among athletes and elderly individuals with osteoporosis.

Average cost per stay: $16,133

Percent of all US hospital stays: 0.9%


14. Peripheral and visceral atherosclerosis

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Flickr/makelessnoise

Atherosclerosis restricts blood flow to the heart by clogging of the inner walls of the arteries.

Average cost per stay: $16,771

Percent of all US hospital stays: 0.4%


13. Fracture of lower limb

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Jeff Egnaczyk/flickr

Broken hips, knees, tibias, ankles, and other lower body bones are included here.

Average cost per stay: $16,796

Percent of all US hospital stays: 0.6%


12. Secondary malignancies

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Carlos Giusti/Getty

New cancers that arrive as a result of treatment of a first cancer are described as secondary malignancies.

Average cost per stay: $17,163

Percent of all US hospital stays: 0.5%


11. Cancer of bronchus, lung

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Walter White was diagnosed with lung cancer in the first episode of “Breaking Bad”
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AMC

Lung cancer – or bronchial carcinoma – is mainly caused by smoking.

Average cost per stay: $17,530

Percent of all US hospital stays: 0.4%


10. Respiratory failure, insufficiency, arrest (adult)

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Sean Gallup/Getty Images

Respiratory failure and insufficiency happens when the lungs cannot produce enough oxygen or expel enough carbon dioxide. Respiratory arrest is the cessation of breathing.

Average cost per stay: $17,868

Percent of all US hospital stays: 1.2%


9. Septicemia

Septicemia – or sepsis – is blood poisoning caused by a bacterial infection.

Average cost per stay: $18,031

Percent of all US hospital stays: 4.3%


8. Spondylosis, intervertebral disc disorders, other back problems

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Andrea_44/Flickr

Spondylosis refers to any degeneration of the spine. Invertebral disc disorders is the breakdown of the discs inbetween the bones of the spine.

Average cost per stay: $18,978

Percent of all US hospital stays: 1.5%


7. Intracranial injury

A traumatic brain injury is a serious blow to the head causing brain dysfunction.

Average cost per stay: $19,539

Percent of all US hospital stays: 0.6%


6. Complication of device, implant or graft

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VCG/VCG via Getty Images

Devices, implants, and grafts are placed in the body during surgery to correct a clinical condition.

Average cost per stay:$20,175

Percent of all US hospital stays: 1.8%


5. Acute myocardial infarction (heart attack)

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Justin Sullivan/Getty

Acute myocardial infarction is the medical name for a heart attack.

Average cost per stay:$20,246

Percent of all US hospital stays: 1.7%


4. Coronary atherosclerosis

Coronary atherosclerosis is a heart disease caused by plaque buildup in arteries, preventing proper blood flow.

Average cost per stay: $20,936

Percent of all US hospital stays: 1.1%


3. Aortic, peripheral, and visceral artery aneurysms

Aneurysms have different names depending on where the weakened artery is located.

Average cost per stay: $34,656

Percent of all US hospital stays: 0.2%


2. Heart valve disorders

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Joe Raedle/Getty

Heart valve disorders is a catch-all term for any illness stemming from the improper use of any of the four heart valves that controls blood flow.

Average cost per stay:$42,647

Percent of all US hospital stays: 0.4%


1. Cardiac and circulatory congenital anomalies

Congenital heart disease and heart murmurs are among this group of heart and lung problems.

Average cost per stay:$63,460

Percent of all US hospital stays: 0.1%

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