From All-Time Low, Proportion of Uninsured U.S. Resident Expected To Climb to 9.2% by 2028, CBO Projects

After reaching an all-time low in 2023, the proportion of people in the U.S. without health insurance coverage is expected to climb steadily over the next decade as a result of a combination of factors, including the end of Medicaid continuous enrollment, a surge in immigration and the scheduled end of enhanced premium subsidies for people buying coverage on the Affordable Care Act (ACA) marketplaces, according to Congressional Budget Office (CBO) projections published as an article in Health Affairs today.

In 2023, 7.2%, or 24 million people, did not have health insurance, according to the CBO. That proportion is expected to jump to 7.7%, or 26 million, this year and then peak to 9.2%, or 32 million people, in 2028, before slipping to 8.9%, or 32 million people, in 2034.

Continuous Medicaid enrollment, which means people were automatically kept on the Medicaid rolls from year to year, was implemented as part of the public health emergency response to the COVID-19 pandemic. It ended last year, and today’s CBO report estimates that the number of people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) will drop from 92 million in 2023 to 79 million in 2024, a 14% decrease. The CBO report attributes some of the short-term rise in the number of people without health insurance to loss of Medicaid coverage.

The CBO report says the recent surge immigration will contribute to the growing percentage of people in the U.S. without health insurance. Lead author Jessica Hale, M.S.P.H., an analyst at CBO, and her colleagues wrote in Health Affairs that CBO expects the uninsured rate among immigrants arriving in the recent surge to be four times the rate of the overall population. The immigration surge, they wrote, will also increase enrollment in employment-based health insurance and to a “much smaller extent” increase Medicare and Medicaid enrollment.

Hale and her colleagues say the number of people who have coverage through the ACA marketplace shot up from 16 million in 2023 to 22 million as a result of people losing Medicaid coverage and premium subsidies that started with the COVID-19 public health emergency and were extended by the Inflation Reduction Act of 2022. But those premium subsidies are scheduled to end in 2025, and the CBO projections show marketplace plan enrollment dipping to 19 million in 2026 and to 16 million in 2027 and staying at either 16 million or 15 million through 2034.