Federal Subsidies for Health Insurance Coverage for People Under 65: 2022 to 2032

In CBO and JCT's projections, net federal subsidies in 2022 for insured people under age 65 are $997 billion. In 2032, that annual amount is projected to reach $1.6 trillion.

The federal government subsidizes health insurance for most Americans under age 65 through various programs and tax provisions. This report, the latest in an annual series, describes updated baseline projections by the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) of the federal costs associated with each kind of subsidy and the number of people with different types of health insurance. Those projections reflect an assumption that laws as of March 23, 2022, governing health insurance coverage and federal subsidies for that coverage remain in place.

Federal Subsidies. In CBO and JCT's projections, net federal subsidies (that is, the cost of all the subsidies minus the relevant taxes and penalties) in 2022 for insured people under age 65 are $997 billion, or 4.0 percent of gross domestic product (GDP). In 2032, that annual amount is projected to reach $1.6 trillion, or 4.3 percent of GDP. Over the 2022-2032 period, subsidies are projected to total $13.4 trillion.

• Medicaid and the Children's Health Insurance Program (CHIP) account for about 42 percent of the federal subsidies annually during the period;
• Subsidies for employment-based coverage, about 37 percent;
• Payments for Medicare enrollees under age 65, about 14 percent; and
• Subsidies for coverage obtained through the marketplaces established by the Affordable Care Act or through the Basic Health Program, about 7 percent.

Health Insurance Coverage. In an average month each year during that period, between 240 million and 246 million people are projected to have health insurance, mostly from employment-based plans. Between 25 million and 29 million people are projected to be uninsured.

Effects of Temporary Policies. Legislation enacted in 2020 and 2021 in response to the coronavirus pandemic has affected CBO and JCT's estimates of federal subsidies and health insurance coverage over the 2021-2024 period. In projections for that period, that legislation:

• Increases enrollment in and subsidies for Medicaid and CHIP,
• Increases enrollment in nongroup coverage purchased through the marketplaces and subsidies for that coverage, and
• Decreases the number of people who are uninsured.

• Data Underlying Figures and Tables

Baseline Projections for Health

• Data and Methods for Constructing Synthetic Firms in CBO's Health Insurance Simulation Model, HISIM2: Working Paper 2021-15
  December 13, 2021
• HISIM2: The Health Insurance Simulation Model Used in Preparing CBO's July 2021 Baseline Budget Projections
  July 6, 2021
• Federal Subsidies for Health Insurance Coverage for People Under 65: 2020 to 2030
  September 29, 2020
• Sources and Preparation of Data Used in HISIM2-CBO's Health Insurance Simulation Model: Working Paper 2019-04
  April 18, 2019