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America's uninsured rate is creeping back up — and it could get a lot worse. A new Commonwealth Fund report finds 11% of U.S. adults are now uninsured, up from 8.9% in 2024, driven by expiring ACA subsidies and the rollback of pandemic-era Medicaid protections. With Medicaid work requirements set to kick in next year, millions more could lose coverage.
America's coverage gains are slipping away. A new Commonwealth Fund report — based on a survey of over 9,300 adults aged 19–64 — finds that 11% of working-age Americans are now uninsured, up from 8.9% in 2024. The culprits? The expiration of enhanced ACA marketplace subsidies and the end of pandemic-era Medicaid protections that had kept millions enrolled.
The affordability picture is equally grim. Nearly half of working-age adults have inadequate insurance — meaning they're either uninsured, had a gap in coverage, or can't afford what they have. Even insured Americans are feeling the squeeze: the share of people delaying or skipping care due to cost rose from 46% in 2022 to 50% in 2026.
Things could get worse before they get better. Starting next year, Medicaid enrollees must log 80 hours of work, schooling, or volunteering monthly to keep coverage — a policy projected to push up to 10 million people off the rolls.
By the Numbers:
Why it matters: Widening coverage gaps don't just affect individuals — they strain emergency systems, increase medical debt, and deepen health inequities. Experts say restoring ACA tax credits and reversing Medicaid cuts are the clearest policy levers to reverse the trend.
