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Presentation at a Press Briefing Organized by Health Affairs
June 18, 2024
Jessica Hale
Budget Analysis Division
Health Insurance Coverage
for the U.S. Population,
2024 to 2034
For information about the press briefing, see https://www.healthaffairs.org/do/10.1377/he20240612.15215/full/. For more information about the Congressional Budget Office’s 2024
baseline projections of health insurance coverage, see Jessica Hale and others, “Health Insurance Coverage Projections for the U.S. Population and Sources of Coverage by Age,
2024–34,” Health Affairs (June 2024), www.healthaffairs.org/doi/10.1377/hlthaff.2024.00460. For more information about CBO’s baseline projections of federal subsidies for that
coverage, see Congressional Budget Office, "Health Insurance and Its Federal Subsidies: CBO and JCT’s June 2024 Baseline Projections” (June 2024), www.cbo.gov/data/baseline-
projections-selected-programs#6.
2
 In 2023, 7.2 percent of the population did not have health insurance, CBO
estimates. That share is projected to rise to 8.9 percent by 2034 because
Medicaid’s continuous eligibility provisions end, enhanced marketplace
subsidies expire, and immigration surges.
 Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) is
projected to decline significantly, from 92 million in 2023 to 79 million in 2034.
 Enrollment through marketplaces is projected to reach an all-time high of
23 million people in 2025.
 Employment-based coverage will continue to be the largest source of health
insurance, while enrollment in Medicare will grow significantly, from 60 million
in 2023 to 74 million in 2034 as the population ages.
Key Points
3
 This year’s projections are for the entire population (defined as the Social
Security area population), expanded from the civilian noninstitutionalized
population under age 65 previously used.
– CBO’s Health Insurance Simulation Model (HISIM2) produces estimates
for the civilian noninstitutionalized population under age 65, which are
supplemented with estimates for the additional segments of the population.
 CBO’s projections incorporate the most recent data, recently enacted
legislation and other policy changes, and the agency’s most recent
macroeconomic forecast.
 The estimates are based on an assumption that legislation enacted through
May 12, 2024, remains in place.
CBO’s Modeling
4
a. Includes people with other kinds of insurance, such as coverage through the Basic Health Program, student health plans, coverage provided by the Indian Health Service, or
coverage from foreign sources.
Projected Health Insurance Coverage, by Calendar Year, 2023 to
2034
Millions of people
2023 2024 2025 2026 2027 2028
Average,
2029 to
2033 2034
Total population 338 342 346 349 352 354 359 363
Employment-based coverage 164 164 164 166 167 168 169 170
Medicaid and Children’s Health Insurance Program 92 79 78 78 79 79 79 79
Medicare 60 61 63 64 66 67 71 74
Nongroup coverage through marketplaces 16 22 23 19 16 16 16 16
Nongroup coverage outside marketplaces 3 3 3 4 4 4 4 4
Other coveragea 7 8 8 9 9 9 9 9
Uninsured 24 26 27 30 32 32 32 32
Multiple sources of coverage
29 21 20 20 21 21 21 21
Share of the population that is
uninsured (percent) 7.2 7.7 7.9 8.7 9.1 9.2 9.0 8.9
5
a. Include policies that allow people with income below 150 percent of the federal poverty level to enroll at any point during the year and policies that eliminate multiple income
verification steps.
b. Include policies that increase funding for navigators and create requirements for longer open enrollment periods.
c. Include policies such as network adequacy requirements, standardized plan options, and changes to essential health benefits.
Explanation of the Increase in Marketplace Enrollment
The unwinding of Medicaid’s
continuous eligibility provisions
and enhanced marketplace
subsidies are the most significant
factors increasing projected
enrollment in 2024 and 2025.
After the enhanced subsidies
expire at the end of 2025,
enrollment declines by an
estimated 7 million by 2027.
Long-term factors (for example,
the affordability test and other
smaller-impact policies)
contribute no more than 4 million
to estimated marketplace
enrollment.
Policies
Impact on
coverage
Years in
effect
Temporary factors
Special enrollment period for the unwinding of
Medicaid’s continuous eligibility provisions Large 2023–2024
Increased generosity of and eligibility for
marketplace subsidies Large 2023–2025
Long-term factors
Changes to affordability standards for dependents Medium 2023–2034
Other policies affecting eligibility determinationsa Medium 2023–2034
Other changes to marketplace operationsb Small 2023–2034
Other changes to marketplace coveragec Small 2023–2034
Policies that are increasing marketplace enrollment, by level of impact on coverage
and years in effect during the 2023–2034 projection period
6
 CBO’s projection of the size of the population each year, on average, over the
2024–2033 period has increased since last year by 8.8 million people, mostly
because of higher net immigration.
– That surge will particularly increase enrollment in employment-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.
 For the 2024–2033 period, average annual enrollment in marketplace coverage
is 3.2 million more than previously projected.
– That increase 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.
Comparison of CBO’s Previous and Current Coverage Projections
7
a. Includes people with other kinds of insurance, such as coverage through the Basic Health Program, student health plans, coverage provided by the Indian Health Service, or
coverage from foreign sources.
Comparison of Previous and Current Projections of Health
Insurance Coverage, by Calendar Year, 2023 to 2033
Millions of people
2023 Average, 2024–2033
September
2023 projection
June 2024
estimate Difference
September
2023 projection
June 2024
projection Difference
Total population 336.0 338.4 2.4 344.8 353.7 8.8
Employment-based coverage 161.3 164.2 2.9 163.8 167.3 3.5
Medicaid and Children’s Health
Insurance Program 90.4 92.0 1.6 79.2 78.8 -0.3
Medicare 60.1 60.1 0 67.3 67.7 0.5
Nongroup coverage through
marketplaces 15.2 16.2 0.9 14.0 17.3 3.2
Nongroup coverage outside
marketplaces 3.6 2.9 -0.7 5.0 3.9 -1.1
Other coveragea 7.5 7.4 -0.1 7.7 8.5 0.8
Uninsured 24.3 24.3 0 29.3 31.0 1.7
Multiple sources of coverage 26.5 28.7 2.2 21.5 20.8 -0.7
Share of the population that is
uninsured (percent) 7.2 7.2 0 8.5 8.8 0.2
8
 CBO’s projections show that health insurance coverage varies considerably by
age.
 In 2024, people ages 19 to 44 have a lower rate of insurance coverage than do
people of other ages, for example. That gap widens by 2034, in part because of
reduced enrollment in marketplace plans.
 Eligibility for several federal health insurance programs (namely, Medicaid,
CHIP, and Medicare) is partially contingent on age.
 Demand for health care and health insurance varies by age, with older people
being more likely than younger ones to be enrolled in coverage.
Health Insurance Coverage by Age
9
Health Insurance Coverage by Age, 2024 and 2034
Children (age 18 and younger)
have the most coverage by
Medicaid and CHIP of any group,
with 32 million enrolled in 2034.
Younger adults (ages 19 to 44)
have the highest number of
uninsured, at 17 million in 2034.
Elderly adults (age 65 and older)
have the lowest number of
uninsured, at 1 million in 2034,
and the highest enrollment in
Medicare, which is projected to
grow substantially, from
54 million to 66 million over the
next decade.
10
 Complex interactions among federal and state policymakers, employers,
households, and insurers make CBO’s projections uncertain.
 CBO’s models rely on imperfect administrative and survey data. Surveys often
have issues with people’s recall, nonresponse, and awareness, and the
pandemic increased that measurement error.
 CBO’s projections are intended to show what would happen to health
insurance coverage if current laws and regulations remained in place, but over
time, applicable laws and regulations do change, and uncertainty increases as
the projections extend.
Sources of Uncertainty in CBO’s Projections

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Health Insurance Coverage for the U.S. Population, 2024 to 2034

  • 1. Presentation at a Press Briefing Organized by Health Affairs June 18, 2024 Jessica Hale Budget Analysis Division Health Insurance Coverage for the U.S. Population, 2024 to 2034 For information about the press briefing, see https://www.healthaffairs.org/do/10.1377/he20240612.15215/full/. For more information about the Congressional Budget Office’s 2024 baseline projections of health insurance coverage, see Jessica Hale and others, “Health Insurance Coverage Projections for the U.S. Population and Sources of Coverage by Age, 2024–34,” Health Affairs (June 2024), www.healthaffairs.org/doi/10.1377/hlthaff.2024.00460. For more information about CBO’s baseline projections of federal subsidies for that coverage, see Congressional Budget Office, "Health Insurance and Its Federal Subsidies: CBO and JCT’s June 2024 Baseline Projections” (June 2024), www.cbo.gov/data/baseline- projections-selected-programs#6.
  • 2. 2  In 2023, 7.2 percent of the population did not have health insurance, CBO estimates. That share is projected to rise to 8.9 percent by 2034 because Medicaid’s continuous eligibility provisions end, enhanced marketplace subsidies expire, and immigration surges.  Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) is projected to decline significantly, from 92 million in 2023 to 79 million in 2034.  Enrollment through marketplaces is projected to reach an all-time high of 23 million people in 2025.  Employment-based coverage will continue to be the largest source of health insurance, while enrollment in Medicare will grow significantly, from 60 million in 2023 to 74 million in 2034 as the population ages. Key Points
  • 3. 3  This year’s projections are for the entire population (defined as the Social Security area population), expanded from the civilian noninstitutionalized population under age 65 previously used. – CBO’s Health Insurance Simulation Model (HISIM2) produces estimates for the civilian noninstitutionalized population under age 65, which are supplemented with estimates for the additional segments of the population.  CBO’s projections incorporate the most recent data, recently enacted legislation and other policy changes, and the agency’s most recent macroeconomic forecast.  The estimates are based on an assumption that legislation enacted through May 12, 2024, remains in place. CBO’s Modeling
  • 4. 4 a. Includes people with other kinds of insurance, such as coverage through the Basic Health Program, student health plans, coverage provided by the Indian Health Service, or coverage from foreign sources. Projected Health Insurance Coverage, by Calendar Year, 2023 to 2034 Millions of people 2023 2024 2025 2026 2027 2028 Average, 2029 to 2033 2034 Total population 338 342 346 349 352 354 359 363 Employment-based coverage 164 164 164 166 167 168 169 170 Medicaid and Children’s Health Insurance Program 92 79 78 78 79 79 79 79 Medicare 60 61 63 64 66 67 71 74 Nongroup coverage through marketplaces 16 22 23 19 16 16 16 16 Nongroup coverage outside marketplaces 3 3 3 4 4 4 4 4 Other coveragea 7 8 8 9 9 9 9 9 Uninsured 24 26 27 30 32 32 32 32 Multiple sources of coverage 29 21 20 20 21 21 21 21 Share of the population that is uninsured (percent) 7.2 7.7 7.9 8.7 9.1 9.2 9.0 8.9
  • 5. 5 a. Include policies that allow people with income below 150 percent of the federal poverty level to enroll at any point during the year and policies that eliminate multiple income verification steps. b. Include policies that increase funding for navigators and create requirements for longer open enrollment periods. c. Include policies such as network adequacy requirements, standardized plan options, and changes to essential health benefits. Explanation of the Increase in Marketplace Enrollment The unwinding of Medicaid’s continuous eligibility provisions and enhanced marketplace subsidies are the most significant factors increasing projected enrollment in 2024 and 2025. After the enhanced subsidies expire at the end of 2025, enrollment declines by an estimated 7 million by 2027. Long-term factors (for example, the affordability test and other smaller-impact policies) contribute no more than 4 million to estimated marketplace enrollment. Policies Impact on coverage Years in effect Temporary factors Special enrollment period for the unwinding of Medicaid’s continuous eligibility provisions Large 2023–2024 Increased generosity of and eligibility for marketplace subsidies Large 2023–2025 Long-term factors Changes to affordability standards for dependents Medium 2023–2034 Other policies affecting eligibility determinationsa Medium 2023–2034 Other changes to marketplace operationsb Small 2023–2034 Other changes to marketplace coveragec Small 2023–2034 Policies that are increasing marketplace enrollment, by level of impact on coverage and years in effect during the 2023–2034 projection period
  • 6. 6  CBO’s projection of the size of the population each year, on average, over the 2024–2033 period has increased since last year by 8.8 million people, mostly because of higher net immigration. – That surge will particularly increase enrollment in employment-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.  For the 2024–2033 period, average annual enrollment in marketplace coverage is 3.2 million more than previously projected. – That increase 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. Comparison of CBO’s Previous and Current Coverage Projections
  • 7. 7 a. Includes people with other kinds of insurance, such as coverage through the Basic Health Program, student health plans, coverage provided by the Indian Health Service, or coverage from foreign sources. Comparison of Previous and Current Projections of Health Insurance Coverage, by Calendar Year, 2023 to 2033 Millions of people 2023 Average, 2024–2033 September 2023 projection June 2024 estimate Difference September 2023 projection June 2024 projection Difference Total population 336.0 338.4 2.4 344.8 353.7 8.8 Employment-based coverage 161.3 164.2 2.9 163.8 167.3 3.5 Medicaid and Children’s Health Insurance Program 90.4 92.0 1.6 79.2 78.8 -0.3 Medicare 60.1 60.1 0 67.3 67.7 0.5 Nongroup coverage through marketplaces 15.2 16.2 0.9 14.0 17.3 3.2 Nongroup coverage outside marketplaces 3.6 2.9 -0.7 5.0 3.9 -1.1 Other coveragea 7.5 7.4 -0.1 7.7 8.5 0.8 Uninsured 24.3 24.3 0 29.3 31.0 1.7 Multiple sources of coverage 26.5 28.7 2.2 21.5 20.8 -0.7 Share of the population that is uninsured (percent) 7.2 7.2 0 8.5 8.8 0.2
  • 8. 8  CBO’s projections show that health insurance coverage varies considerably by age.  In 2024, people ages 19 to 44 have a lower rate of insurance coverage than do people of other ages, for example. That gap widens by 2034, in part because of reduced enrollment in marketplace plans.  Eligibility for several federal health insurance programs (namely, Medicaid, CHIP, and Medicare) is partially contingent on age.  Demand for health care and health insurance varies by age, with older people being more likely than younger ones to be enrolled in coverage. Health Insurance Coverage by Age
  • 9. 9 Health Insurance Coverage by Age, 2024 and 2034 Children (age 18 and younger) have the most coverage by Medicaid and CHIP of any group, with 32 million enrolled in 2034. Younger adults (ages 19 to 44) have the highest number of uninsured, at 17 million in 2034. Elderly adults (age 65 and older) have the lowest number of uninsured, at 1 million in 2034, and the highest enrollment in Medicare, which is projected to grow substantially, from 54 million to 66 million over the next decade.
  • 10. 10  Complex interactions among federal and state policymakers, employers, households, and insurers make CBO’s projections uncertain.  CBO’s models rely on imperfect administrative and survey data. Surveys often have issues with people’s recall, nonresponse, and awareness, and the pandemic increased that measurement error.  CBO’s projections are intended to show what would happen to health insurance coverage if current laws and regulations remained in place, but over time, applicable laws and regulations do change, and uncertainty increases as the projections extend. Sources of Uncertainty in CBO’s Projections