Skip to main content
The Keckley Report

Special Report: Physicians on the Brink or At the Starting Line?

By May 30, 2023No Comments

Tomorrow, America’s Physician Groups (APG) will kick-off its Annual Spring Conference “Going the Distance” in San Diego with breakout sessions focused on wide ranging operational issues and 3 general sessions that address restoring trust in the profession, lessons from the pandemic and Medicare Advantage.

Next Thursday, the American Medical Association (AMA) will kick off its 5-day House of Delegates session in Chicago with a plethora of resolutions and votes on the docket and committee reports on issues like the ethical impact of private equity on physicians in private equity owned practices, health insurer payment integrity and much more.

These meetings are coincident with the expected resolution of the debt-ceiling dispute in Congress which essentially leaves current Medicare and Medicaid payments to physicians and others in tact through 2025. So, for at least the time being, surprises in insurer payments to physicians are not anticipated.

Nonetheless, it’s a critical time for APG and AMA as their members face unparalleled market pressures:

  • Trust in the profession has eroded. Media attention to its bad actors has expanded.
  • Settings have changed: the majority now work as employees of large groups owned by hospitals or private equity sponsors.
  • Consumer (patient) expectations about physician quality, access and service are more exacting.
  • Technologies that improve precision in diagnostics and therapies and integration of social determinants in care planning have altered where, how and by whom care is delivered.
  • Affordability and lack of price transparency are fundamental concerns for U.S. consumers (and voters), employers and Congress. While drug PBMs, hospitals and health insurers are a focus of attention, physicians are not far behind.
  • Private equity and retail giants are creatine formidable competition in primary and specialty care.
  • Media coverage of “bad actors” engaged in fraudulent activity (i.e. unnecessary care, medications, et al) has increased.
  • Operating losses in hospitals remain significant limiting hospital investments in their employed medical practices.

Both organizations remain steadfast in the belief that the future for U.S. healthcare is physician centric:

  • For APG, it’s anchored in a core belief that changing payer incentives from fee-for-service to value is the essential means toward the system’s long-term sustainability and effectiveness. (APG represents 335 physician organizations)
  • For AMA, “true north” is the profession’s designated role as caregivers and stewards of the public’s health and wellbeing. (AMA’s membership includes 22% of the nation’s 1.34 million practicing physicians, medical students and residents).

But market conditions have taken their toll on physician psyche even as CMS has altered its value agenda.

Physicians are highly paid professionals. Per Sullivan Cotter and Kaufman Hall, their finances took a hit during the pandemic and their finances in 2022-2023 has been stymied by inflationary pressures. Thus, most worry about their income and they’re hyper-sensitive to critics of their compensation.

Fueling their frustration, virtually all believe insurance companies are reimbursement bullies, hospitals spend too much on executive salaries (aka suits) and administration and not enough on patient care and patients are increasingly difficult and unreasonable. Most think the profession hasn’t done enough to protect them and 65% say they’re burned out. That’s where APG and AMA find themselves relative to their members.

My take:

The backdrop for the APG and AMA meetings in the next 2 weeks could not be more daunting. Inflationary pressures dog the health economy as each advances an advocacy agenda suitable to their member’s needs. But something is missing: a comprehensive, coherent, visionary view of the health system’s future in the next 10-20 years wherein physicians will play a key role. That view should include…

  • How value and affordability are defined and actualized in policies and practice.
  • How the caregiver workforce is developed, composed and evaluated based on shifting demand.
  • How incentives should be set and funding sourced and rationalized across all settings and circumstances of service.
  • How consumerism can be operationalized.
  • How prices and costs in every sector (including physician services) can become readily accessible.
  • How a seamless system of health can be built.
  • How physician training and performance can be modernized to participate effectively in the system’s future.

The U.S. health system’s future is not a repeat of its past.  Recognizing this, physicians and the professional associations like APG and AMA that serve them have an obligation to define its future state NOW.

Some physicians are on the brink of despair; others are at the starting line ready to take on the challenge.



America’s Physician Groups’ Annual Spring Conference “Going the Distance” in San Diego May 31-June 2, 2023

Trusted Voice, Powerful Ally 2023 ANNUAL MEETING OF THE House of Delegates June 9-13 in Chicago

Quotable: Special Focus on Physicians

Gallup: medical professions occupational trust: “For the poll, Gallup surveyed a national sample of 1,020 U.S. adults across all 50 states and the District Columbia between Nov. 9 and Dec. 2, 2022. Respondents were asked to rate the honesty and ethical standards of different professions.

Nurses were ranked as the most trusted profession in the United States, with 79% of respondents saying they had “high” or “very high” honesty and ethical standards. They have held this distinction for over 20 years now.

In addition to nurses, two other medical professions—medical doctors (62%) and pharmacists (58%)—made up the top three spots.

However, Gallup noted that respondents’ ratings for all three professions have dipped since the start of the pandemic and are now below their pre-pandemic levels. For nurses, this year’s rating is the lowest it has been since 2004, while the current doctors’ rating is the lowest it’s been since 1999, and pharmacists’ the lowest in 40 years.

However, medical professionals remain more trusted than many other professions. The only other profession that was highly trusted was high school teachers at 53%. The remaining professions, which include real estate agents, bankers, and judges, largely garnered “average” ratings on their honesty and ethics. A few, such as telemarketers and members of Congress, received mostly “low” or “very low” ratings.”


Re: primary care corporatization: ”It’s no surprise that the shortage of primary care doctors — who are critically important to the health of Americans — is getting worse.

They practice in one of medicine’s lowest paid, least glamorous fields. Most are overworked, seeing as many as 30 people a day; figuring out when a sore throat is a strep infection, or managing a patient’s chronic diabetes.

So why are multibillion-dollar corporations, particularly giant health insurers, gobbling up primary care practices? The appeal is simple: Despite their lowly status, primary care doctors oversee vast numbers of patients, who bring business and profits to a hospital system, a health insurer or a pharmacy outfit eyeing expansion. But now, nearly seven in 10 of all doctors are either employed by a hospital or a corporation, according to a recent analysis from the Physicians Advocacy Institute.

The companies say these new arrangements will bring better, more coordinated care for patients, but some experts warn the consolidation will lead to higher prices and systems driven by the quest for profits, not patients’ welfare.

Corporate Giants Buy Up Primary Care Practices at Rapid Pace The New York Times Abelson May 8, 2023Updated May 12, 2023

Re: Primary care physician participation in value-based programs: “71% of respondents reported that their practice was receiving any FFS payments, while fewer than half (46%) reported receiving any VBP. Similar rates of primary care practices report receiving two common types of VBP, shared savings or capitation (30% and 32%, respectively). Participation in VBP was associated with efforts to provide higher-quality and more comprehensive care. PCPs in practices receiving VBP, compared to those not receiving these payments, were more likely to report participating in accountable care organizations (66% vs. 24%) or patient-centered medical homes (53% vs. 30%). These care delivery models have been shown to improve quality of care for patients while reducing costs. PCPs receiving VBP were also slightly more likely than those not receiving VBP to report screening patients for social drivers of health (66% vs. 60%), an important step in addressing the social needs that affect patients’ physical health outcomes.

Celli Horstman and Corinne Lewis, “Engaging Primary Care in Value-Based Payment: New Findings from the 2022 Commonwealth Fund Survey of Primary Care Physicians,” To the Point (blog), Commonwealth Fund, Apr. 13, 2023.

Re: physician spending: “Although physician services was the second largest category of health spending, prior to the pandemic, spending on physician services generally grew more slowly than spending in the other large categories of personal health care. Physician spending grew by an average of 3.8% per year between 2009 and 2019 while hospital services (4.5%) and clinical services (6.6%) had higher growth rates.”


Re: physician supply: “The U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years, according to The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 (PDF), a report released by the Association of American Medical Colleges (AAMC).

Specific AAMC projections by 2034 include shortages of:

  • Between 17,800 and 48,000 primary care physicians.
  • Between 21,000 and 77,100 non-primary care physicians.

This includes shortages of:

  • Between 15,800 and 30,200 for surgical specialties.
  • Between 3,800 and 13,400 for medical specialties.
  • Between 10,300 and 35,600 for other specialties.

As of 2021, there were around 946,800 active doctors of medicine in the U.S. This was around 29.9 physicians per 10,000 civilian population1.”

“The Complexities of Physician Supply and Demand: Projections From 2019 to 2034” AAMC June 2021 www/

Re: physician over-utilization:” But a ProPublica analysis of CMS data suggests that if the agency had reviewed its own figures, it would have discovered that Dormu was part of a small pool of physicians performing a disproportionate number of treatments. From 2017 to 2021, the analysis shows, the top 5% of doctors conducting atherectomies — about 90 physicians overall — accounted for more than a third of all procedures and government payments, totaling nearly a billion dollars.

Near the top of the list sits Dormu, logging more atherectomies — and making more money from them — than almost every other doctor in America. CMS paid Dormu more than $30 million in the past decade for vascular procedures he performed on hundreds of patients.

In the “Wild West” of Outpatient Vascular Care, Doctors Can Reap Huge Payments as Patients Risk Life and Limb May 24, 2033

Re: physician fraud discipline lax: “Over the last decade alone, at least 540 doctors and healthcare practitioners collectively paid the government hundreds of millions of dollars to negotiate their way out of trouble via civil settlements, then continued to practice medicine without restrictions on their licenses despite allegations that included fraud and patient harm, a Reuters investigation found…

Separately, more than 2,200 hospitals and healthcare companies likewise negotiated civil deals to sidestep prosecution for alleged offenses that included paying bribes, falsifying patients records and billing the government for unnecessary patient care…

The U.S. government collected more than $26.8 billion in healthcare-related civil settlements and judgments from 2013 to 2022..

In all, the news agency examined 2,788 federal civil settlement cases and administrative actions over that time period; that figure includes the 540 cases of doctors and other healthcare practitioners who kept their licenses after agreeing to civil deals. Most cases were jointly investigated by the Justice Department and the OIG of Health and Human Services.”

Michael Berens A Reuters Special Report: How doctors buy their way out of trouble May 24, 2023

Re: cancer care financial burden: “Financial toxicity is the economic burden patients experience from the costs related to getting treatment for their cancer. Cancer care is expensive. By one 2020 estimate, the average cost of medical care and drugs is more than $42,000 in the year following a cancer diagnosis. To complicate matters, up to 85% of cancer patients leave the workforce during their initial treatment. Consequently, more than 40% of patients spend their entire life savings in the first two years of treatment, while roughly 30% of Americans with a cancer history report having had problems paying their medical bills, having to borrow money, or filing for bankruptcy protection because of their cancer. In addition, informal caregivers, often family members, also experience out-of-pocket and opportunity costs, estimated to be upwards of several thousand dollars per month.

In 2022, the United States celebrated the 50th anniversary of the National Cancer Act and the war on cancer. It took decades, but those initiatives produced the remarkable innovations in detection and treatment that have led to today’s improved cancer survival and reductions in mortality rates in the United States. Now, it is critically important for the United States to address the growing financial toxicity that too often accompanies potentially lifesaving cancer tests and treatments, to ensure patients’ focus can remain on cure — not cost.”

Ezekiel J. Emanuel Cancer patients shouldn’t be responsible for out-of-pocket costs STAT May 23, 2023 /

Other quotables from last week

Re: hospital influence: “The hospital industry has long been a lobbying powerhouse in Washington. Not only are hospitals willing to spend mightily on their advocacy, but their altruistic, care-giving reputations, coupled with their presence in nearly every congressional district in the country, have earned them the favor of most politicians.

But now, hospitals are worried the onslaught of the billionaires’ parallel campaigns could threaten their bottom lines only two years after they were the health care system’s frontline defense against the Covid-19 pandemic.

The studies question whether nonprofit hospitals provide enough care to the poor to truly deserve their tax breaks, estimate the savings to the federal government from policies to make sure hospitals aren’t paid more for services than physician offices, and interrogate how some hospitals’ massive investment portfolios impact their bottom lines.

The billionaires’ message is resonating on Capitol Hill. House committees have held seven hearings addressing hospital costs and market power so far this year, and legislation supported by the billionaire groups has started progressing through the process Congress uses to approve laws.

The Energy & Commerce Committee voted to unanimously advance the bill on Wednesday, and during a recent hearing on the issue in the House Ways & Means Committee, Smith referenced meeting with Fat Joe on the issue of transparency and Fisher’s data on hospital compliance.”

Rachel Cohrs “With Fat Joe concerts and Super Bowl ads, a cadre of billionaires is mounting an unorthodox campaign against hospitals” May 25, 2023

Re: health system transformation: “American health care is broken. And American health care systems must transform radically to lead the repair.

Let’s first look at the data: The U.S. now spends more than $4 trillion a year on health care. That’s nearly 20% of gross domestic product. Yet U.S. life expectancy lags literally dozens of other nations—including Portugal, Slovenia, and Turkey—by as much as seven years. If trends continue, we will drop to 64th in the world in life expectancy by 2040, though we will continue to spend significantly more per capita than nearly any other nation.

Hospitals and health care systems have enormous wealth. The biggest—even those technically listed as non-profits—have billions in cash and investments on their balance sheets, and some rang up record surpluses during the pandemic. Health care systems also have enormous clout: They’re often among the biggest employers in a region and a source of substantial political donations.”

Donald M. Berwick and Michelle A. William American Health Care Is Broken. Major Hospitals Need to Be Part of the Solution Time

Re: covid disinformation: “More research is needed to include these factors, but the estimate used in this analysis is that misinformation and disinformation cause between 5% and 30% of voluntary nonvaccination in the United States. This is based on experimental studies on misinformation that showed a 6% decrease in vaccination intent and comparison of total numbers receiving influenza vaccines compared to those receiving COVID-19 vaccines. About 23% of people not vaccinated against SARS-CoV-2 say they normally get an annual flu shot. Even accounting for fear of novelty, it seems plausible that much of this difference is caused by misinformation and disinformation. As of early October 2021, about 22% of the US adult population, or 43 million people, have chosen nonvaccination, so we estimate that between 2 and 12 million people are unvaccinated because of misinformation or disinformation.”

COVID-19 Vaccine Misinformation and Disinformation Costs an Estimated $50 to $300 Million Each Day Johns Hopkins Center for Health Security /

Re: MedTech investing: “Medtech enjoys large market opportunities across its many sub-markets, and while existing markets are already massive, we see emerging opportunities in the areas of personalized medicine, liquid biopsies, medical aesthetics, and portable therapies….There were 439 VC deals in medtech with a combined deal value of $8.7 billion in 2022, down from the 561 deals and deal value of $9.7 billion in 2021. While this wasn’t a significant difference on a year-over-year basis, total funding has declined each quarter since early 2022, which is in line with ongoing deterioration in the overall VC funding environment.”

Pitchbook Launch Report: Medtech VC and PE trends and industry overview


Kaufman Hall: % Changes from Q1 23 vs. Q1 22:

  • APP % of total providers: 39% (+1.2%)
  • Net patient revenue per Provider FTE: $357,507 (+16%)
  • Provider wRVU per FTE: 4740 (+8%)
  • Physician wRVU per FTE: 5731 (+9%)
  • Total direct expense per Provider FTE: $611,317 (+17%)
  • Provider comp per FTE: $297,350 (+13%)
  • Physician comp per FTE: $360,345 (+13%)

Physician Flash Report: Q1 2023 Kaufman Hall May 3, 2023

MGMA: Physician comp up in 2022:  Median total compensation for primary care doctors rose 4.41% last year, compared with 2.13% in 2021, according to a Medical Group Management Association analysis released Thursday. Highlights:

  • Primary care physician pay varies regionally. Providers in the southern and western regions experienced the largest increases in compensation from 2019 through 2022. Compensation increased 11.4% in the western region, compared with 6.5% in the eastern region.
  • No specialties kept up with inflation. Total compensation for surgical and nonsurgical specialists cooled in 2022, dropping to 2.54% in 2022, from 3.89% a year earlier, for surgical specialists and to 2.36% last year, from 3.12% in 2021 for nonsurgical physicians.  Advanced practice practitioners saw their pay increase ebb slightly, to 3.70%, down from 3.98% in 2021.

Related: ”Average physician pay fell by 2.4% from 2021 to 2022… according to the sixth annual Physician Compensation Report from professional medical network Dimity. The average pay for doctors increased by 3.8% from 2020 to 2021, which was up from a nominal increase of 1.5% in 2020. According to the American Medical Association, when adjusted for inflation, Medicare physician payment declined 22% from 2001 to 2021.”


Sullivan Cotter: ’s Large Clinic® Compensation and Productivity Survey for 2023.  Some interesting market movement, with the

  • Total cash compensation (TCC) market increased 5.1% in 2023 vs 2022 driven by primary Care (+11.5%) medical, surgical and hospital-based specialties (+4.1%, +4.6% and +.2%) respectively.
  • “wRVUs increased by 5.4%; however, TCC/wRVU rates remained flat at a 0.9% increase (due to wRVUs moving at approximately the same overall rate as TCC).”

“This movement wasn’t completely surprising due to 1-Ongoing volume increase from the pandemic, 2 pressure from inflation, 3-. supply of physicians and 4-. movement to the 2021 Physician Fee Schedule or resulting in an increase in wRVUs especially office-based evaluation and management codes.”.

Courtney Dutton, CCP, Managing Principal, SullivanCotter, Inc. Large Clinic® Compensation and Productivity Survey for 2023

KFF analysis: higher out of pocket costs for preventive services: Background: KFF analyzed private insurance claims data to examine the number of people who received preventive services that could be affected by a now-stayed U.S. District Court ruling in Braidwood Management v. Becerra, which found the Affordable Care Act’s (ACA) preventive services mandate partially unconstitutional. Finding:

“In this analysis, we find that at least 1 in 20 privately insured people (5.7%) received any of the ACA preventive services or drugs potentially affected by Braidwood Texas district court ruling. According to the American Community Survey, 173 million non-elderly people have private health insurance coverage. Based on this, we estimate up to nearly 10 million people could face higher out-of-pocket costs if the district court ruling stands and insurers ultimately decide to implement cost-sharing.”

Use of ACA preventive care potentially affected by Braidwood v. Becerra Peterson KFF Health System Tracker May 25, 2023

Physician mental health gets attention in Stark Law revision:, Congress issued a new exception for physician wellness programs offered by healthcare entities, including ASCs, hospitals and physician practices.

“The statutory exceptions are related to “physician wellness programs,” defined as mental and behavioral health programs offered to a physician that have a primary goal of preventing suicide, improving mental health and resiliency, and providing training on strategies to promote better mental health. In addition, Congress has adopted a requirement that DHHS consider whether a new safe harbor should be adopted for contingency management interventions.”

“Hidden in Plain Sight: Lesser-Known Exceptions Recently Adopted by Congress to the Federal Physician Self-Referral Law and Anti-Kickback Statute” Epstein, Becker and Green May 15, 2023


Hospitals, Health systems

Vanderbilt-Phillips deal announced: Last Tuesday, Vanderbilt University Medical Center and Philips  announced a new partnership that will look to mitigate its carbon footprint in MR, CT, ultrasound, and X-ray scanner use. Per the announcement, the healthcare industry contributes 7.6% of U.S. and 4.4% of global CO2 emissions, with radiology a significant contributor due to its heavy energy, equipment, and supply use.

Vanderbilt, Philips explore tactics to reduce radiology’s carbon footprint Healthcare Business May 23, 2023


Fed household survey: The Survey of Household Economics and Decisionmaking was conducted by the Federal Reserve  Oct. 21 to Nov. 1 with 11,775 responses. Findings: in 2022…

  • 35% of Americans said their financial situation was worse in 2022 than the year prior
  • 23% of adults had major, unexpected medical expenses, with the median amount between $1,000 and $1,999
  • 16 % of adults had debt from medical care for themselves or a family member, though not necessarily accrued in the past year.
  • 28% of adults went without some form of medical care because they could not afford it. The top five: medical services Americans did not undergo due to cost: Dental care: 21%, Physician or specialist visit: 16%, Prescription medication: 10%, Follow-up care: 10%, Mental healthcare: 10%
  • Families with income less than $25,000, 75% reported being in good health vs. 91% for those with income of $100,000 or more.

Survey of Household Economics and Decisionmaking The top 5 medical services Americans are skipping May 23, 2023

Bankruptcies up to 12 year high: A new report from S&P Global has shown that the number of companies that have gone bankrupt so far in 2023 is higher than the first four months of any year since 2010. Filings through April have pushed the year-to-date count to 236 — more than double the comparable figure a year ago and higher than any of the prior 12 years. Leading the way were companies selling directly to consumers, followed by industrials and then financial services.

The good news is that these numbers are still lower than pre-COVID, but the bad news is that they’re growing — and it’s yet another conflicting metric that’s baffling economists. GDP has been growing (although slowing). Unemployment is at a 50-year low. Consumer spending has stayed the course. Companies in the services industries are doing well. Travel has recovered from the pandemic. Why so many bankruptcies? The answer is one word: capital.

American Bankruptcy Institute Analysis: Bankruptcies Are Skyrocketing — and That’s Only Half the Story Monday, May 22, 2023

Employers, Insurers

NC Report: dual eligibles cost: Researchers analyzed North Carolina claims-based utilization and spending data for dual eligibles (Medicare beneficiaries with full Medicaid benefits) from 2014-2017. Findings:

  • The combined total spending for the programs was $26,874 per person-year (PPY), with the distribution between the two evenly split at $14,175 for Medicare and $12,698 for Medicaid.
  • Subgroups (% of total enrollees, PPY and % paid thru Medicaid): community well (64.1%, $19,734/38.5%), home- and community-based services (HCBS) (15%, $40,069/ nursing home (NH) residents (7.5%, $68,359/70.1%), and intensive behavioral health (BH) users (15.2%)

Kaufman et al “Health Care Use and Spending Among Need-Based Subgroups of Medicare Beneficiaries with Full Medicaid Benefits” JAMA Health Forum May 12, 2023. 2023;4(5):e230973. doi:10.1001/jamahealthforum.2023.0973

Study: weight loss drug coverage by employers: EBRI: Among employer-sponsored plans, 22% said they offered coverage for prescription weight-loss drugs in 2022, according to the International Foundation of Employee Benefit Plans’ annual survey of 502 organizations across 20 industries and ranging in size from fewer than 50 to more than 10,000 employees.

GLP-1 drugs, including Ozempic, Trulicity, Victoza and Mounjaro, are used to treat Type 2 diabetes. Wegovy and Saxenda, which have the same active ingredient, are specifically approved for weight loss. The drugs can cost upward of $10,000 annually without insurance coverage.

Employee Benefits Survey: 2022 Results


Study: high cost drug spending in Medicare, commercial coverage: Researchers compared out-of-pocket spending for ultra-expensive drugs for Medicare Part D beneficiaries with commercial insurance. Findings:

  • Mean out-of-pocket spending per beneficiary per drug in 2019 was $4478 in Part D compared with $1821 for commercial.
  • Mean out-of-pocket spending per beneficiary per drug in 2019 was $4301 in Medicare Advantage prescription drug (MAPD) plans, $4575in stand-alone prescription drug plans (PDPs), $1208 in health maintenance organization plans, $1569in preferred provider organization plans, and $4077 in high-deductible health plans.

DiStefano ”Comparison of Out-of-Pocket Spending on Ultra-Expensive Drugs in Medicare Part D vs Commercial Insurance” JAMA Health Forum. 2023;4(5):e231090. doi:10.1001/jamahealthforum.2023.1090


Health Capital Analysis: site neutral payment policy would save Medicare $231B in first year: “The April 26, 2023 congressional hearing focusing on the promotion of competition and transparency in healthcare referenced 17 bill drafts, several of which relate directly to site-neutral payments…

Adopting site-neutral payment policies would result in estimated savings of over $471 billion to the Medicare program and Medicare beneficiaries over the next decade: Medicare’s savings would be approximately $202 billion for the first year, while enrollees would save approximately $67 billion on cost sharing and an additional $67 billion on Part D premiums. Plus, private health insurance plan premiums would be reduced by 0.75% in aggregate (due to the link between private insurer payment rates and Medicare payment rates). The reduction in private insurance premiums increasing federal tax revenues by $29 billion, meaning that adopting this site-neutral payment policy would result in total federal government savings of $231 billion in the first year alone. In addition, private plan enrollees would save $18 billion on cost sharing from the payment of lower rates, resulting in total out-of-pocket savings of $152 billion for enrollees in both private and Medicare plans.”

Congress Mulling Medicare Site-Neutral Payment Policy Health Capital Topics May 2023 /

“Site-neutral payment policies could save Medicare $471 billion” By Jeff Lagasse, Healthcare Finance, March 6, 2023,

CBO: uninsured rate expected to increase to 10.1% by 2033: The Congressional Budget Office estimates that in 2023, 248 million people in the US who are younger than age 65 have health insurance coverage (mostly through employment-based plans), and 23 million people, or 8.3% of that age group, are uninsured—with significant variations in coverage by income and, to a lesser extent, by race and ethnicity. As the continuous eligibility provisions unwind in 2023 and 2024, an estimated 9.3 million people in that age group will transition to other forms of coverage, and 6.2 million will become uninsured. If the enhanced subsidies expire after 2025, 4.9 million fewer people are estimated to enroll in Marketplace coverage, instead enrolling in unsubsidized nongroup or employment-based coverage or becoming uninsured. By 2033 the uninsurance rate is projected to be 10.1%which is still below the 2019 rate of about 12%.

Hanson “Health Insurance for People Younger Than Age 65: Expiration of Temporary Policies Projected to Reshuffle Coverage, 2023–33” Health Affairs May 24, 2023