Uninsured Rate Rises to 11.2% as Coverage Erodes Before Medicaid Cuts

The uninsured rate among US adults aged 19 to 64 years rose from 8.9% in 2024 to 11.2% in 2026, a statistically significant increase that coincided with falling Affordable Care Act (ACA) marketplace and Medicaid enrollment, according to the Commonwealth Fund's 2026 Biennial Health Insurance Survey.¹

“These declines in coverage and affordability are occurring even before Medicaid cuts and major changes to the program go into effect in 2027,” wrote the authors of the report. “The survey also shows that a majority of the country believes the federal government has a responsibility to ensure that all Americans have health care coverage.”

Overall, 46% of working-age adults were inadequately insured in 2026: 11% were uninsured, 12% had a coverage gap during the year, and 23% were underinsured, meaning their plan did not provide affordable access to care. The research firm SSRS surveyed a nationally representative sample of 9360 adults aged 19 years and older from May 7 through July 20, 2026; most analyses focused on 7,362 respondents aged 19 to 64 years.

Uninsured Rate Pushes to 11.2% Amid Marketplace and Medicaid Losses

ACA marketplace and individual market coverage fell from 8.5% in 2024 to 6.4% in 2026, and Medicaid coverage declined from 15.5% in 2022 to 13% in 2026. Young adults aged 19 to 34 years and adults with household incomes under 200% of the federal poverty level ($31,300 for an individual and $64,300 for a family of 4) saw declines in both ACA and Medicaid coverage alongside rising uninsured rates.

The authors said the declines are consistent with the end of 2 pandemic-era policies: continuous Medicaid enrollment and enhanced premium tax credits. The expiration of enhanced tax credits raised average annual premiums by $750 to $4035 depending on income. The Trump administration also ended a special enrollment period for people earning less than 150% of poverty.

Federal data show a similar trend. Effectuated marketplace enrollment, which counts only people who paid their premiums, fell 13%, from 22.1 million in 2025 to 19.2 million in February 2026, according to a KFF analysis; the administration has attributed the drop to its antifraud efforts.²

The survey findings precede the major provisions of H.R. 1, the 2025 tax and spending law, which take effect in 2027.¹ These include Medicaid work requirements of 80 hours per month for most expansion enrollees and eligibility redeterminations every 6 months, changes projected to produce net Medicaid enrollment losses of 11.5 million over the next decade. The Congressional Budget Office projects separate marketplace changes, combined with rising premiums, will reduce enrollment by 7.5 million.

Half of Working-Age Adults Avoided Care Because of Cost

The share of working-age adults who did not get needed care because of cost rose from 46% in 2022 to 50% in 2026, a statistically significant increase that also held among people insured all year.

Among adults insured all year, 30% were underinsured, including 29% of those with employer-sponsored insurance and half of marketplace enrollees. Among marketplace enrollees, 19% said they moved to lower-premium plans with higher deductibles and out-of-pocket costs after the enhanced tax credits lapsed.

More than half of marketplace enrollees did not get needed care because of cost, and one-third were paying off medical bills over time, compared with 43% and 31%, respectively, among people with employer coverage. Overall, 3 in 10 working-age adults reported paying off medical debt.

73% Say Federal Government Should Ensure Coverage

Nearly three-quarters (73%) of adults aged 19 years and older said the federal government has a responsibility to ensure all Americans have health coverage, including 93% of Democrats, 76% of Independents, and 45% of Republicans.

The Commonwealth Fund outlined several policy options, including permanently extending the enhanced premium tax credits, eliminating Medicaid work requirements, giving states the option of 12-month continuous Medicaid eligibility, creating an autoenrollment mechanism, and eliminating deductibles in commercial plans paired with caps on provider payment rates.

“Congress and the executive branch have the tools to address the escalating affordability and coverage problems facing Americans,” wrote the authors. “They can ensure everyone has good, affordable health insurance and health care. The people we surveyed are signaling to policymakers that the federal government has a responsibility to do this.”

References

1. Collins SR, Cil G, Richards C. The state of health insurance coverage in 2026: findings from the Commonwealth Fund 2026 Biennial Health Insurance Survey. Commonwealth Fund. Published October 22, 2026. Accessed October 21, 2026. doi:10.26099/e0eb-0g78
2. Cox C. ACA marketplace enrollment is down by 3 million after big jump in premium payments. KFF. June 29, 2026. Accessed October 21, 2026. https://www.kff.org/quick-insights/aca-marketplace-enrollment-is-down-by-3-million-after-big-jump-in-premium-payments/