About 30.6 million Americans will obtain their health insurance through exchanges by 2019, according to a new government estimate.

That figure, included in the office of Medicare’s chief actuary report on the effects of the health reform law, contrasts the estimated 24 million to use exchanges by 2019 in a Congressional Budget Office report published earlier this year.

On Jan. 1, 2014, all states must provide health exchanges where individuals, families and small businesses can compare insurance rates and obtain coverage. The health exchanges are part of the federal health reform law passed by Congress and President Barack Obama in March.

The same Medicare report indicates that federal and state agencies will use $37 million over the next decade to create and operate those exchanges, according to the New York Times. It is the first government estimate of the cost of those controversial exchanges.

The total spending of the nation on health care spending because of the passage of federal health reform will remain flat for the next 10 years, the Medicare report said. The difference in health care spending will be negligible, 6.3%, compared to the 6.1% projected without the passage of the law in March, according to the New York Times. The law provides a means for 32.5 million uninsured Americans to obtain health insurance.

The chief Medicare actuary’s report, published Sept. 8 on the online version of the journal Health Affairs, suggests that Medicare spending cuts coupled with a new tax on so-called Cadillac insurance plans,  or high-cost employer-sponsored health plans, will make up for additional spending on Medicaid and subsidized health benefits for low-income people. The Medicare cuts begin later this year, while the Cadillac plan cuts take hold in 2018, both under the provisions of The Patient Protection and Affordable Care Act.

“In the aggregate,” Andrea M. Sisko, the principal author of the report, according to the New York Times, “it appears that the new law will have a moderate effect on health spending growth rates and the health care share of the economy.”

National spending on public and private health care totaled $2.5 trillion in 2009, a number representing 17.3% of the economy. By 2019, the report pegs national health spending at $4.6 trillion and 19.6% of the national economy, the newspaper reported.