Patient financial services professionals should expect an increase in the number of uninsured patients for the next two years until health insurance exchanges and other provisions of the Patient Protection and Affordable Care Act take full effect.

Congress’s watchdog, the Congressional Budget Office, issued its forecast for the next years, and in a surprise to no one, warned that funding healthcare will be Congress’s biggest challenge. An aging  population and provisions of the ACA will strain federal budgets for the next 10 years and beyond.

For those who manage the healthcare revenue cycle, the next two years will be especially challenging. The CBO has revised its projections of the number of people with employment-based coverage (the good news: there will will be more) and the number of uninsured (also increasing). That two-year bump will fade once health insurance exchanges are online and fully functional and Medicaid is fully expanded, the CBO predicts. “The number of people gaining coverage through the exchanges rises from 7 million in 2014 to 24 million in 2016, and the number gaining coverage through Medicaid rises from 8 million in 2014 to 11 million in 2016,” according to the CBO report.

The expected drop in employer-sponsored health-insurance enrollees is the result of lower marginal tax rates instituted as part of the American Taxpayer Relief Act of last year. “Lower marginal tax rates … will reduce the relative attractiveness of  employment-based insurance for low-income workers and for their employers,” the CBO report states. “The change in tax law will increase the number of people who shift out of employment-based coverage as a result of the Affordable Care Act by 2 million to 3 million people, many of whom are expected to obtain insurance through the exchanges.

By 2022, the CBO estimates that an estimated 3 million fewer people will have employer-based health insurance than originally projected. “The increased movement out of employment-based coverage also reflects revisions to CBO’s projections of income over time and higher projections of employment-based coverage in the absence of the Affordable Care Act,” the report states. This will be a plus for federal coffers because more of a worker’s income becomes taxable, the report states.