Medicaid and CHIP

CBO responds to a request for an analysis of the distributional effects of H.R. 1, the One Big Beautiful Bill Act, and updates the preliminary analysis it provided in a letter dated May 20, 2025.

CBO periodically issues a compendium of policy options and their estimated effects on the federal budget. This report presents 76 options for altering spending or revenues to reduce federal budget deficits over the next decade.

CBO estimates how expanding certain children’s eligibility for Medicaid or the Children’s Health Insurance Program over the next 10 years would affect the U.S. economy and the federal budget through the end of the century.

CBO published updated baseline projections of health insurance coverage and federal subsidies for it. The projections are described in an article published in the journal "Health Affairs" and a presentation on CBO’s website.

On a present-value basis, CBO estimates that long-term fiscal effects of Medicaid spending on children could offset half or more of the program’s initial outlays, depending on sets of reasonable parameter values.

CBO estimates that the Center for Medicare & Medicaid Innovation’s (CMMI’s) activities increased federal spending between 2011 and 2020 and will also increase it from 2021 to 2030. In 2010, CBO projected that CMMI would produce savings.

In 2023, federal subsidies for health insurance are estimated to be $1.8 trillion, or 7.0 percent of gross domestic product (GDP). In CBO and JCT’s projections, those net subsidies reach $3.3 trillion, or 8.3 percent of GDP, in 2033.

CBO describes features of the Medicare and Medicaid improvement funds and how the funds are accounted for in CBO’s baseline and cost estimates.

CBO estimates the budgetary effects of options for expanding federal Medicaid payments to states for services provided to Medicaid enrollees ages 21 to 64 who are in inpatient facilities known as institutions for mental diseases.

CBO issues a volume describing 17 policy options that would each reduce the federal budget deficit by more than $300 billion over the next 10 years or, in the case of Social Security options, have a comparably large effect in later decades.

CBO issues a volume that contains short descriptions of 59 policy options that would each reduce the federal budget deficit by less than $300 billion over the next 10 years.

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.

In 2019, about 12 percent of people under 65 were not enrolled in a health insurance plan or a government program that provides financial protection from major medical risks. In this report, CBO describes that uninsured population.