The share of working-age Americans without health insurance has risen to 11.2% this year, according to the Commonwealth Fund’s Biennial Health Insurance Survey published Oct. 22.
The survey is based on interviews with more than 9,300 adults conducted from May through July. The CDC’s most recent National Health Interview Survey, covering 2025, had pegged the overall uninsured rate at 8.3% across all age groups.
The increase in uninsured adults coincided with the expiration of enhanced ACA marketplace premium subsidies at the end of 2025 and continued Medicaid enrollment declines that began after pandemic-era protections ended. The coverage losses are occurring before major provisions of H.R. 1 take effect in 2027, when Medicaid work requirements, six-month eligibility redeterminations, and more marketplace changes are projected to lead to net enrollment losses of 11.5 million in Medicaid and 7.5 million in marketplace plans over the next decade. The total number of uninsured individuals could hit 37 million by 2036.
Four things to know:
- ACA marketplace and individual market coverage fell to 6.4% of the total insured working-age population in 2026 from 8.5% in 2024. Medicaid enrollment among working-age adults also dropped, falling to 13% from 15.5% in 2022. The expiration of enhanced premium tax credits led to average annual premium increases of $750 to $4,035 depending on income, according to the Urban Institute.
- Nearly half of working-age adults (46%) were inadequately insured in 2026. That includes the 11% who were uninsured, 12% who had a gap in coverage during the year, and 23% who were underinsured, meaning their plan did not provide affordable access to care.
- Young adults ages 19 to 34 have been hit the hardest, with their uninsured rate jumping to 16% from 11% over the past two years. Low-income working-age adults with household incomes below 200% of the federal poverty level also saw significant coverage losses in both ACA and Medicaid plans.
- Half of working-age adults reported going without needed care because of cost, up from 46% in 2022. Three in 10 were paying off medical debt.
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