For the second year in a row, the uninsured rate held steady at 8.0% in 2024 according to new data released by the Census Bureau from the Current Population Survey (CPS) and remains at a near historic low. During the pandemic, the uninsured rate dropped to the lowest level, driven by policies that paused Medicaid disenrollments and provided enhanced Affordable Care Act (ACA) Marketplace premium tax credits. As the Medicaid continuous enrollment policy came to an end, states resumed renewals and disenrollments and Medicaid coverage declined. But, the Medicaid declines were offset by increases in private coverage, particularly coverage through the Marketplaces, resulting in no change in the uninsured.
For the total population, Medicaid coverage dropped by 1.3 percentage points from 2023 to 2024 while private coverage increased by 0.7 percentage points, including a 0.5 percentage point increase in direct purchase coverage (Figure 1). (Medicare coverage grew, as is expected as the population ages.) These patterns held for both children and adults ages 19-64. The changes reflect the unwinding of Medicaid continuous enrollment that began in April 2023 and continued through 2024. At the same time, the continued availability of enhanced Marketplace tax credits first adopted by the American Rescue Plan Act (ARPA) in 2021 and later extended through the end of 2025 by the Inflation Reduction Act (IRA) has led to record growth in ACA Marketplace enrollment.
While robust Marketplace enrollment helped keep the uninsured rate low in 2024, the expiration of the enhanced premium tax credits for Marketplace enrollees, which will happen at the end of 2025 unless Congress acts to extend them, will increase the number of people without health insurance. The Congressional Budget Office (CBO) projects that about 4 million more people will be uninsured in 2034 if the enhanced Marketplace subsidies are allowed to expire.
Looking further into the future, changes to Medicaid and the ACA Marketplaces made by the budget reconciliation package (formerly called the “One Big Beautiful Bill Act”) that was signed into law by President Trump on July 4, 2025 are expected to increase the number of people who are uninsured in the coming years. The law imposes new work requirements and more frequent eligibility determinations for some Medicaid enrollees and limits how states can finance their share of Medicaid spending. It also restricts immigrant eligibility for both Medicaid and the subsidized Marketplace coverage and will make it harder for individuals to renew Marketplace coverage and enroll in Marketplace coverage following a change in circumstances. CBO estimates that the law will increase the number of people without health insurance by 10 million in 2034. Combined, the expiration of the enhanced tax credits and the changes in the reconciliation law will lead to about 14 million more people without health insurance in 2034.
This projected increase in the number of people who are uninsured would reverse more than a decade of coverage gains under the ACA. The impact on access and affordability of health care will be significant for those who lose coverage, leading to reduced use of health services, increased financial burden and medical debt, and worse health outcomes.