More working-age Americans are going without health insurance, and the biggest coverage cuts haven’t even started yet.
The share of U.S. adults ages 19 to 64 with no health insurance rose from 8.9% in 2024 to 11.2% in 2026, according to the Commonwealth Fund’s 2026 Biennial Health Insurance Survey, released Thursday. The foundation called the increase statistically significant. It comes after a stretch from 2010 to 2025 in which the national uninsured rate fell by half.
The survey ties the jump to two changes that hit at the end of 2025: the expiration of the enhanced Affordable Care Act premium tax credits, and the end of pandemic-era rules that kept people enrolled in Medicaid. Larger Medicaid cuts and new limits on marketplace coverage under H.R. 1, the 2025 budget law, start in 2027.
“The country is on the brink of undoing years of progress in health coverage,” said Sara R. Collins, the study’s lead author and a Commonwealth Fund senior scholar.
Who is losing health coverage?
The losses show up in the two programs that drove coverage gains under the ACA. The share of working-age adults with marketplace or other individual plans fell from 8.5% in 2024 to 6.4% in 2026. Medicaid coverage among working-age adults fell from 15.5% in 2022 to 13%.
Young adults were hit hardest. The uninsured rate for people ages 19 to 34 rose from 11% to 16% in two years. Among adults with household incomes below 200% of the federal poverty level, which is $31,300 for a single person and $64,300 for a family of four, the uninsured rate rose from 14% to 17%.
The report points to an estimated 3 million people who dropped marketplace coverage after the enhanced tax credits ended. Among those who stayed, 19% said they moved to cheaper plans with higher deductibles and out-of-pocket costs.
How many Americans are skipping care because of cost?
Half of working-age adults said they went without needed care in the past year because of cost, up from 46% in 2022. That includes not filling a prescription, skipping a recommended test or treatment, not seeing a doctor when sick, or not getting specialist care.
Having insurance didn’t always help. The survey found that 46% of working-age adults were inadequately insured: 11% were uninsured when surveyed, 12% had a gap in coverage during the year, and 23% were insured all year but underinsured, meaning their out-of-pocket costs or deductibles were high relative to their income.
Medical debt is common across coverage types. Among adults insured all year, 31% of those with employer coverage and 33% of those with marketplace or individual plans said they were paying off medical bills or debt. Employer plans are getting pricier as well; KFF found this week that workers now pay $7,471 a year toward family coverage, up 9% from 2025.
What happens to coverage in 2027?
The researchers expect more losses. H.R. 1 requires many adults in the Medicaid expansion group to show they are working or doing approved activities for 80 hours a month, and it requires states to recheck their eligibility every six months. The report says those changes are expected to lead to net Medicaid enrollment losses of 11.5 million people over the next decade.
On the marketplace side, the law bars most legal immigrants from premium tax credits next year and adds stricter documentation rules in 2028. Congressional Budget Office estimates cited in the report project that federal policy changes will leave 37 million people uninsured by 2036, about the same number as in 2014, when the ACA’s main coverage expansions began.
Out-of-pocket exposure is rising too. The report notes that the maximum out-of-pocket limit for commercial plans is set to climb to $12,000 for an individual and $24,000 for a family in 2027.
What do Americans think the government should do?
Nearly three-quarters of adults said the federal government has a responsibility to make sure everyone has health coverage. That view was held by 93% of Democrats, 76% of independents and 45% of Republicans.
The Commonwealth Fund urged Congress to restore the enhanced marketplace tax credits, drop Medicaid work requirements, create a coverage option for people in the 10 states that have not expanded Medicaid, and keep medical debt off credit reports. Its president, Dr. Joseph R. Betancourt, a primary care physician, said that when people can’t afford care, “treatable illnesses become medical emergencies.”
The survey was conducted by SSRS from May 7 to July 20, 2026, and included 9,360 adults, with 7,362 between ages 19 and 64.
For people who lost coverage, the next chance to shop for a marketplace plan begins with open enrollment on Nov. 1 at HealthCare.gov. People whose income has dropped may also qualify for Medicaid, which takes applications all year. For those already cutting back on medications, HNC’s guide to lowering prescription costs is a place to start.
Key takeaways
- The uninsured rate for working-age adults rose from 8.9% in 2024 to 11.2% in 2026, the Commonwealth Fund reported on Oct. 22, 2026.
- Marketplace coverage fell to 6.4% of working-age adults and Medicaid coverage to 13%, after enhanced ACA tax credits and pandemic-era Medicaid protections ended.
- Half of working-age adults skipped needed care because of cost, and 46% were uninsured, had a coverage gap or were underinsured.
- Medicaid work requirements and six-month eligibility checks start in 2027. CBO estimates cited in the report put the uninsured at 37 million by 2036.
Frequently asked questions
What is the uninsured rate in 2026?
According to the Commonwealth Fund’s 2026 Biennial Health Insurance Survey, 11.2% of working-age adults ages 19 to 64 were uninsured in 2026, up from 8.9% in 2024.
Why is the number of uninsured Americans rising?
The survey links the increase to the expiration of enhanced ACA marketplace premium tax credits at the end of 2025 and the end of pandemic-era protections that kept people enrolled in Medicaid.
When do the Medicaid work requirements start?
Under H.R. 1, Medicaid work requirements for many adults in the expansion group and six-month eligibility checks begin in 2027. Most adults covered would need to show 80 hours a month of work or approved activities unless exempt.
Can I still get marketplace coverage if I lost my plan?
Yes. Marketplace open enrollment starts Nov. 1 on HealthCare.gov or your state’s exchange, and a job loss or other life change can open a special enrollment period. Medicaid accepts applications year-round.
