💬 Discussion
Illustration for the category Health
United States · Federal (Medicare, Medicaid match, Marketplace subsidies) · COFOG 07.6

Health Coverage and Costs

This area covers who is insured in the United States, on what terms, and what the country pays for care — the Medicare and Medicaid programmes, the subsidised Marketplace, and the prices the federal payers set. It does not cover public health, drug approval, or the training of the clinical workforce.

Where things stand

The United States spent 5.3 trillion dollars on health care in 2024, 15,474 dollars a head and 18.0 percent of economic output, and the actuaries project that share to reach 20.6 percent by 2034. Coverage is assembled from four blocks that Congress adjusts separately: employer plans, Medicare, Medicaid and CHIP for 73.9 million people, and the subsidised Marketplace. In 2025 some 28.0 million people of all ages, 8.3 percent, had no coverage at all, and that count grew by roughly 800,000 over the year. Two decisions taken in 2025 are now working through the system in opposite directions from that baseline. The enhanced Marketplace premium tax credits lapsed at the end of 2025, net premium payments for people signing up for 2026 rose 58 percent, and average monthly enrolment is expected to fall from 22.3 million to about 17.5 million. The 2025 reconciliation law adds work-reporting requirements in Medicaid from January 2027, which the budget office scores at 4.8 million more uninsured people. Medicaid enrolment has meanwhile already fallen by 5 million, or 6 percent, in the year to April 2026. On the price side the federal payers are moving the other way: Medicare began paying the same rate for drug administration in off-campus hospital outpatient departments as in physician offices in 2026, and broader versions of that policy are scored in the hundreds of billions.

Facts & figures
18.0% of GDP
National health spending, 5.3 trillion dollars or 15,474 dollars a head
↗ rising, projected 20.6% by 2034
28.0 million (8.3%)
People of all ages without health insurance
↗ rising, about 800,000 more than in 2024
17.5 million
Expected average monthly Marketplace enrolment, against 22.3 million in 2025
↘ falling, first decline since 2019
+58%
Increase in premium payments net of tax credits for people signing up for 2026 coverage
↗ rising, the enhanced credits lapsed at the end of 2025
73.9 million
People enrolled in Medicaid and CHIP, 38.3 million of them adults
↘ falling, 5 million fewer than a year earlier
4.8 million
Additional uninsured people the budget office attributes to the Medicaid work-reporting requirement
↗ rising, the requirement starts nationally in January 2027
157 billion dollars
Ten-year federal saving the budget office scores for full site-neutral payment in Medicare outpatient care
→ stable, a standing budget option since 2022
Sources: Centers for Medicare & Medicaid Services, National Health Expenditure Fact Sheet · National Center for Health Statistics, National Health Interview Survey · KFF, 2026 ACA Marketplace enrolment, premiums and deductibles · Medicaid.gov, Medicaid and CHIP enrolment data highlights · KFF, work requirement provisions in the 2025 reconciliation law · Congressional Budget Office, budget option: reduce payments for hospital outpatient departments — as of 2024–2026, last reviewed 09/2026

Overview

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1× better · 2× balanced · 1× worse · 4 on the previous scale (r) Scale: share of runs in which for − against > 0 · Scoring v1.3

Proposals

4 evaluated · sorted by balance
Last reviewed by Claude Opus 5 · September 6, 2026 · 1× AI, not yet reviewed by a human
  1. September 6, 2026AI reviewClaude Opus 5First evaluation

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