Report: Insurance market instability threatens millions

A new report from The Center for Health and Economy (H&E) sheds light on the current state of insurance coverage in America for customers under 65 and the realized and potential impacts of policy reforms.

In 2024, H&E estimates that 91% of Americans under 65 have health insurance. Coverage falls into four categories: the individual market, employer-sponsored insurance, Medicaid, and other public insurance.

H&E estimates that 26-million non-elderly Americans are currently uninsured. The report notes that this figure represents an increase over past years and credits it to the end of COVID-19 Medicaid extensions and rising premiums in the individual market.

In addition to the end of COVID-era benefits, a number of other factors are driving changes in the health insurance landscape. Non-elderly Medicaid beneficiaries are estimated at 72 million in 2024, increasing to 74 million by 2034, partly due to North Carolina’s Medicaid expansion. The individual market is projected to decline from 16 million in 2024 to 7 million by 2034, driven by premium increases. However, this decrease is partly offset by rising Medicaid enrollment. The Biden Administration’s 2023 fix of the ACA’s “family glitch,” which previously limited the affordability of employer-sponsored insurance for families, is expected to boost individual market enrollment by approximately 1 million.

Notably, H&E predicts that the number of individuals with unsubsidized, individual market insurance will hold steady at 4 million from 2026 to 2034. The report notes, however, that rising costs and higher income contributions for subsidized enrollees may lead to increased uninsured rates later.

Read more: Private plans cover more Americans: CDC

Rising premium costs and less generous subsidies are also predicted to change customers’ marketplace choices. Specifically, the report foresees some number of current Silver plan enrollees migrating to Bronze plans. Future Silver plan enrollment is predicted to disproportionately comprise households that are eligible for premium credits. On that same note, the distribution of subsidized enrollment of the four metal levels is expected to become overall less evenly distributed going forward.

With regards to the federal budget for non-elderly health insurance, the report estimates a cost of $6.73 trillion from 2024-2033. That figure represents a slight decrease from last year’s estimate because of increasing plan costs and a decrease in the number of customers able to purchase subsidized individual plans. The report notes, however, that the estimate does not take into account tax expenditures that are not related to the Affordable Care Act, like the employer-sponsored health insurance tax expenditure.