The nation’s uninsured rate is expected to rise exponentially if ACA premium tax credits expire and GOP lawmakers implement new Medicaid policies as part of a broader budget reconciliation package.
In 2024, the U.S. uninsured rate across all ages was 8.2%, which corresponds to 27.1 million people.
Medicaid
House Republicans unveiled legislation May 11 that would introduce Medicaid work requirements nationwide and stricter eligibility guidelines.
The bill aims to reduce federal spending by hundreds of billions of dollars over the next decade, with Medicaid and ACA programs facing the majority of the proposed cuts. The House Energy and Commerce Committee advanced the legislation on May 14 in a 30-24 vote.
According to new estimates from the Congressional Budget Office, the proposed Medicaid policies would lead to 10.3 million people losing health coverage and 7.6 million people going uninsured by 2034.
The CBO projects that some of the proposed policies would lead to at least $625 billion in savings. Work requirements would save nearly $301 billion over the next decade.
ACA
Starting in 2026, the enhanced premium tax credits will no longer be available unless Congress acts to extend them. According to CMS data published May 12, 24.3 million people enrolled in ACA coverage for 2025, a 13% increase from 2024.
On May 13, the House Ways and Means Committee advanced its markup of its portion of the budget reconciliation bill, which did not include an extension of the tax credits.
The expiration of the tax credits is projected to lead to about 7 million fewer enrollees by 2027, and the number of uninsured individuals is projected to increase by 5.4 million, according to an analysis by Oliver Wyman.
Healthier enrollees are projected to leave the individual ACA market at a higher rate than
those with more significant healthcare needs, and enrollment among ages 18 to 34 would drop by over 47%.
Average net premiums per enrollee receiving tax credits are projected to increase by 90%, an increase of about $1,200 per enrollee annually.
