Image by Koi Roylers from PixabayEach year, the U.S. Centers for Medicare & Medicaid Services (CMS) Office of the Actuary teams with Health Affairs to release a sweeping forecast of national health care spending.
The 2025 edition projects another decade of strong growth – with major implications for ambulatory surgery centers (ASCs) operating at the crossroads of surgical care, cost containment and shifting reimbursement dynamics.
The main takeaways: Health care is getting more expensive, growing faster than the overall U.S. economy and increasingly shaped by government payers. That’s both a challenge and an opportunity for ASCs.
National spending trends
In its forecast, CMS estimated that total national health care expenditures rose by 8.2% in 2024, reaching over $5.2 trillion. In 2025, that growth is expected to slow slightly to 7.1%, but still well above the projected 4.6% gross domestic product (GDP) growth for the year.
Over the full 2024 through 2033 projection window, health care spending is expected to grow at an average annual rate of 5.8%, compared to 4.3% for GDP. If that happens, health care will account for 20.3% of the U.S. economy by 2033 – up from 17.6% in 2023.
A primary driver of the nation’s health care spend, of course, is an aging population.
Baby boomers are aging into Medicare through 2029. For ASCs, in turn, that means increasing overall demand for surgeries, diagnostics and chronic disease management – core components of surgery center service lines.
More specifically, CMS projects that spending on physician and clinical services, or the category most closely aligned with ASC procedures, grew by 7.8% in 2024. That growth translated to spending hitting over $1 trillion for the first time.
Expenditure growth is expected to remain strong at 6.6% in 2025, before tapering to 5.1% in the latter half of the decade.
Source: “National Health Expenditure Projections, 2024–33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDP”
Medicare projections
ASCs also play a growing role in Medicare cost strategy.
CMS expects Medicare spending to grow 7.7% in 2025, with the program’s long-term average outpacing both Medicaid and commercial insurance growth through 2033.
For ASCs, this could mean more surgical volume from Medicare beneficiaries. At the same time, there could be more administrative and reimbursement complexity due to expanding Medicare Advantage (MA) enrollment.
While MA growth helped contain overall Medicare fee-for-service inflation in 2024, CMS projects surging enrollment and increased utilization of outpatient procedures will continue to elevate total program costs.
This dynamic is putting more pressure on ASCs to contract effectively with MA plans and navigate varying authorization and bundled payment rules.
Meanwhile, private payer growth is expected to slow in the second half of the decade as enhanced Affordable Care Act subsidies expire. That’s something to monitor for ASCs with a high concentration of commercially insured, elective surgical volume.
Beyond the bottom line
Hospital care spending rose to a projected $1.66 trillion in 2024, making it the largest category of U.S. health care expenditure by far.
CMS continues to emphasize site neutrality and migration of procedures as levers to reduce hospital outpatient costs.
With ongoing inflation pressures and payer pushback on hospital pricing, ASCs are well-positioned to absorb more same-day volume, especially in specialties such as orthopedics, ophthalmology and cardiovascular care.
National health care expenditures on hospital care are projected to reach more than $2.69 trillion by 2033.
Other health care categories and subcategories projected to grow relatively rapidly toward the second half of the coming decade include home health care, which CMS forecasts to grow by 7.8% between 2028 and 2033.
