Health care was the top issue for Americans voting in Tuesday's midterm elections — for an understandable reason. Spending on medical care has skyrocketed in the past 20 years, hitting record levels in 2018 and weighing on both workers and employers. More U.S. voters cited it as their top concern on the ballot, ahead of the economy or any other issue, for the first time in at least a decade, according to exit polls by NBC News. Forty-one percent of those polled cited health care as their top issue, followed by immigration, at 23 percent. Roughly 70 percent of all voters, Democrat and Republican, said the U.S. health-care system needs "major changes," while only 4 percent said it needed no changes at all.

Economy

Spending on medical care is the highest it has ever been. The United States spends 18.2 percent of gross domestic product on health care, up slightly from 2017, according to Statista. That amount has jumped more than 260 percent since 1960, when the U.S. spent 5 percent of GDP on health costs. In the past decade alone, the percentage of costs to GDP has risen roughly 10 percent. Americans spend twice as much as any other high-income country in the world on medical care. Yet utilization rates in the United States were largely similar to those in other nations, according to a recent academic paper published by the Journal of the American Medical Association. High prices for doctors and nurses, pharmaceuticals and administrative costs were major reasons for the disconnect in overall cost between the United States and other high-income countries, according to the research. Even with the higher spending, Americans are certainly not healthier. Americans smoke less than other high-income countries but have a higher rate of obesity and infant mortality. The average life expectancy is nearly three years lower than other high-income countries, such as the United Kingdom, France and Australia. The U.S. also has lower rates of coverage than other high-income countries. More than 90 percent of Americans have health care after the enactment of the Affordable Care Act, or ACA, but every other top 10 nation by comparison has at least 99 percent coverage for its population, according to the study. Source: PwC Health Research Institute analysis of CMS national health expenditure data and Bureau of Economic Analysis data.

Employers & workers

Companies are taking on a lot of that cost burden. Employer spending on health care as a percentage of wages has doubled since the 1980s, to about 12 percent from 6 percent, according to a PwC Health Research Institute analysis of CMS national health expenditure data and Bureau of Economic Analysis data. Annual premiums for employer-sponsored family health coverage rose 5 percent this year, to $19,616, outpacing the 2.8 percent increase in wages, according to Kaiser Family Foundation. But workers are paying more too, an average of $5,547 toward the cost of their coverage. That number is up more than 250 percent from 1999, when workers paid just $1,543 of their total average $5,791 annual premium costs. To compare that to other household costs, the Bureau of Labor Statistics estimates prices for housing were 57 percent higher this year versus 1999. During the same time frame, median household income rose just 2 percent, in 2017 dollars, according to data from the U.S. Census Bureau. Source: Kaiser Family Foundation

Debate