But here’s the problem behind those numbers. One of the few consistent trends in annual national health spending data, since 1960, is that in almost every year, the share of out-of-pocket spending has declined. In the last full year on record (2011), it dropped again, to 11.39 percent. And when the ACA’s expanded subsidies and rules for insurance coverage kick in during 2014, out-of-pocket spending is projected to fall to 10.15 percent of total national health spending and continue to drop down to reach 9.4 percent in 2021. This trend alone is expected to increase spending.