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Uninsured rate to rise to 8.9% by 2034, CBO finds

Employment-based coverage will be the predominant source of health insurance, and Medicare enrollment will grow significantly.

Jeff Lagasse, Editor

Photo: Basak Gurbuz Derman/Getty Images

The percentage of Americans who lack health insurance, which currently hovers around 7.2%, is projected to rise steadily through the years, hitting 8.9% by 2034, according to the latest data presented by the Congressional Budget Office.

In a report published in Health Affairs, the CBO said this trend is largely a result of the end of COVID-19 pandemic-related Medicaid policies, the expiration of enhanced subsidies available through the Affordable Care Act health insurance marketplaces and a surge in immigration that began in 2022.

The largest increase in the uninsured population will be among adults ages 19-44. Employment-based coverage will be the predominant source of health insurance, and as the population ages, Medicare enrollment will grow significantly, according to the CBO.

After greater-than-expected enrollment in 2023, marketplace enrollment is projected to reach an all-time high of twenty-three million people in 2025.

WHAT'S THE IMPACT?

Jessica Hale, coauthor of the Health Affairs study, said during a press call today that the estimates are based on the assumption that legislation enacted through May 12, 2024 remains in place.

The CBO's projections show that health insurance coverage varies considerably by age. In 2024, people ages 19 to 44 have a lower rate of coverage than do people of other ages. That gap will widen by 2034, said Hale, in part because of reduced enrollment in marketplace plans.

Children 18 and under have the most coverage by Medicaid and CHIP of any other group, with 32 million projected to be enrolled by 2034. Younger adults, those ages 19 to 44, will have the highest uninsured rate at that time, at roughly 17 million.

Elderly adults (65 and older) will have the lowest uninsured rate, at about one million, in 2034. They'll also have the highest enrollment in Medicare, which is projected to grow substantially, from 54 million to 66 million over the next decade.

Medicaid coverage will likely tell a different story.

"Numerous data sources indicate the number of people with Medicaid has risen recently," said Hale. "We expect the recent increase to be reversed after the Medicaid continuous eligibilities end. That's also why we don't expect employer-based coverage to increase much in response."

CBO's projection of the size of the population each year, on average, over the study period has increased by 8.8 million people over last year's projection, mostly because of higher net immigration. According to Hale, that surge will particularly increase enrollment in employer-based coverage and increase the number of people without insurance.

To a much smaller extent, the immigration surge will also increase Medicaid and marketplace coverage. From 2024 to 2033, average annual enrollment in marketplace coverage is 3.2 million more than previously projected. That increase, according to the CBO, is due to higher-than-expected transitions from Medicaid to marketplace coverage and a larger-than-expected impact of the availability of enhanced marketplace subsidies.

THE LARGER TREND

Employment-based coverage will continue to be the largest source of health insurance, with enrollment between 164 million and 170 million, data showed.

As the population ages, Medicare enrollment will rise from 60 million in 2023 to 74 million in 2034. Following enrollment numbers that were higher than expected in 2023, 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 roughly seven to eight million after 2025, when the enhanced marketplace subsidies expire.

In addition, after the expiration of Medicaid's COVID-19 pandemic-related continuous eligibility provisions, the number of people with multiple sources of coverage will decline from 29 million in 2023 to 21 million in 2034.

Jeff Lagasseiseditor of Healthcare FinanceNews.
Email:jlagasse@himss.org
Healthcare FinanceNews is aHIMSSMedia publication.