CMS reports that national health care spending grew at 4.0% in 2009, to a total of $2.5 trillion. While this is the slowest rate of growth in decades (attributable to the recession), health care spending growth continued to exceed overall economic growth, which declined 1.7%. While private health insurance spending increased only 1.3% in 2009, Medicaid enrollment growth triggered a 9.0% increase in Medicaid spending (as a result of Recovery Act funding, federal Medicaid spending increased 22% while state Medicaid spending fell 9.8%). Medicare spending rose by 7.9% in 2009 to $502.3 billion. With regard to types of care: hospital spending increased 5.1% to $759.1 billion; physician/clinical services spending rose 4.0% to $505.9 billion; retail prescription drug spending grew 5.3% to $249.9 billion; spending for freestanding nursing care facilities/continuing care retirement communities increased 3.1% to $137.0 billion; home health care services grew 10.0% to $68.3 billion; and spending for durable medical equipment decreased 0.8% to $34.9 billion.