Without changes in federal policy, the number of Americans without health insurance will grow from about 45 million in 2009 to about 54 million in 2019, the Congressional Budget Office said. Driving the increase will be health insurance premiums that rise faster than incomes. The CBO says premiums will increase to keep ahead of increased costs of medical breakthroughs that are extending and improving people's lives. Also contributing to higher insurance costs will be wasteful and unnecessary medical care, the report found.