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Congressional Budget Office Projects Increase of Uninsured Over the Next 10 Years

The Congressional Budget Office (CBO) is projecting an increase in the uninsured rate over the next 10 years, to 8.9% of the U.S. population in 2034, up from 7.2% in 2023, according to a study published recently in Health Affairs.

The CBO expects the largest increase in those who are uninsured will be in the 19-44 age group, due in large part to the end of the Medicaid continuous eligibility provision that was in place during the pandemic and the expiration of enhanced marketplace subsidies after 2025. Additionally, the increase in immigration since 2022 will be a contributing factor as immigrants will have a much higher uninsurance rate than the rest of the U.S. population.

Over the next 10 years, it is estimated the current population of approximately 342 million will rise to more than 360 million, with employment-based coverage continuing to be the largest source of health insurance, covering between 164 million and 170 million people. In the same time period, as the population ages, Medicare enrollment is estimated to increase from 60 million in 2023 to 74 million in 2034.

The study notes that enrollment through the marketplaces established by the Affordable Care Act is projected to reach a new high of 23 million in 2025 and then decline by up to 8 million after 2025, when the enhanced marketplace subsidies expire. Another area of decline involves the expiration of Medicaid’s COVID-19 pandemic related continuous eligibility provisions. The end of these provisions is expected to decrease the number of people with multiple sources of coverage from 29 million in 2023 to 21 million in 2034.

CHIP and Medicare

Expected to experience a steep decline, enrollment in the Children’s Health Insurance Program (CHIP), which in Ohio is an extension of Medicaid, is projected to decline from 92 million in 2023 to 79 million in 2024. This sudden drop is largely attributed to the ending of Medicaid’s continuous eligibility provisions. CBO expects the states to complete their eligibility redeterminations by Sept. 2024 and projects the enrollment in CHIP and Medicaid will stabilize at 78 million beneficiaries in 2025 and 2026.

As the U.S. population continues to age, Medicare enrollment is expected to climb from 62 million in 2024 to 74 million by 2034. More than half of all Medicare enrollees with parts A and B coverage were enrolled in Medicare Advantage in 2023, and on the basis of trends in enrollment and payments, the CBO expects that share to rise to nearly two-thirds by 2034.

Coverage by Age

The graph below illustrates the predicted shifts in health insurance coverage by age from 2024 to 2034. This is due in part to eligibility for some federal health insurance programs, including Medicaid, CHIP, and Medicare, and is contingent on age.

Additionally, the need for healthcare and health insurance varies over the course of one’s life, with older people being more likely than younger ones to be enrolled in coverage. The CBO notes that two main drivers of projected changes in coverage — the unwinding of Medicaid’s continuous eligibility provisions and the end of enhanced marketplace subsidies for nongroup coverage — will probably have different effects depending on people’s age.