CMS projection: 90% of Americans will still have health insurance in 2034—when healthcare spending reaches $9T

Legislative changes, demographic shifts and growing demand will combine to drive national health spending to almost $9 trillion by 2034.

Researchers at the Centers for Medicare and Medicaid Services make the projection in a report published June 24 in Health Affairs.

CMS economist Jacqueline Fiore, PhD, and colleagues note the $9T figure will represent 20.6% of the economy, up from $5.3T and 18.0% in 2024.

Meanwhile the insured share of the population is expected to drop slightly, from 91.8% in 2024 to 90.5% in 2034. 

Key takeaways from the report include these three.  

National health expenditure projections for the coming decade are heavily influenced by several key drivers. 

Growth in the use of medical services and goods is expected to remain heightened through 2026, the authors explain, whereas various provisions from recent legislation are expected to reduce enrollment in private health insurance and Medicaid and to slow Medicaid spending growth through 2028. 

‘Despite these declines in coverage, the insured share of the population is expected to be more than 90% in 2034.’

Health spending is expected to continue growing faster than economic resources (GDP and disposable personal income). 

The use of medical services and goods drives these trends, Fiore and co-researchers state.  

‘On a per-enrollee spending basis, private health insurance, Medicare and Medicaid are all anticipated to increase above 5.0% per year between 2025 and 2034.’

Policymakers will continue to explore options for addressing the significant financing challenges for a sector that is expected to account for more than one-fifth of the economy by 2034. 

The financing concerns must be considered within the context of aligning the goals of technological advancement—perhaps driven by progressions in AI that could be cost-increasing or cost-decreasing—with improved population health and health insurance coverage, the researchers write.

‘To the extent that new legislation is enacted that affects coverage patterns or payment rates or that the assumptions used in this analysis differ from the ultimate outcomes, such events may result in deviations between health spending and insurance enrollment projections and actual experience.’

Fiore and team point out that their projections are produced using actuarial and econometric modeling methods. In some instances they adjusted projections “regarding the degree to which other factors may affect future health spending and health insurance enrollment.” 

The projections were finalized in April, they note, and are consistent with the economic and demographic assumptions from the 2026 Medicare trustees report (officially the 2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds).

To read the full CMS report by Fiore et al. in Health Affairs, click here.