CBO Projects 16 Million Increase in Uninsured Due to ACA and Medicaid Changes
The Congressional Budget Office (CBO) has projected that the One Big Beautiful Bill Act (OBBA) will result in an estimated increase of 10.9 million uninsured individuals. This includes 3.1 million people uninsured due to changes in the Affordable Care Act (ACA) Marketplaces. Additional factors, such as the expiration of enhanced premium tax credits by the end of the year and proposed ACA Marketplace integrity rules from the previous administration, are also expected to contribute significantly to higher uninsured rates. In total, these projections estimate an increase of 8.2 million uninsured individuals attributable specifically to ACA Marketplace changes and an overall increase of 16 million uninsured once Medicaid changes are included.
The ACA Marketplace adjustments involve technical and policy changes expected to impact accessibility and affordability. Notably, new income verification rules could increase barriers to coverage by requiring more stringent documentation instead of self-attestation. Other provisions may also affect individuals with fluctuating incomes, complicating their ability to maintain Marketplace coverage. Furthermore, the expiration of enhanced premium tax credits is anticipated to raise out-of-pocket premium costs by over 75% for those subsidized, with insurers forecasting an average premium rate increase of 4% due to a projected shift toward a sicker enrollee base.
Geographically, the ACA Marketplace changes are predicted to disproportionately affect Southern states. Florida, with the largest ACA Marketplace enrollment nationally, could see an additional 9% of its population become uninsured because of these changes. Other states with significant increases include Georgia (6%), Texas (5%), Mississippi (5%), and South Carolina (4%). Florida, Texas, and Georgia alone are expected to account for over half of the 8.2 million ACA Marketplace-related coverage losses, exacerbating regional disparities in insurance coverage.
This analysis highlights that while Medicaid cuts have garnered attention, ACA Marketplace modifications represent an equally critical factor in projected insurance coverage declines. These shifts underscore the evolving complexities in healthcare policy and the interplay between federal provisions and state-level impacts. The findings prompt close attention from insurers, policymakers, and stakeholders focused on coverage stability, affordability, and regulatory compliance in the post-2025 health insurance landscape.