The share of working-age adults without health insurance rose to 11.2% in 2026 from 8.9% in 2024, according to the Commonwealth Fund's 2026 Biennial Health Insurance Survey released October 22, with the losses concentrated in the marketplace and Medicaid a year before the cuts to both programs take effect.
SSRS fielded the survey from May 7 to July 20, reaching 9,360 adults age 19 and older in the continental United States by telephone and online, in English and Spanish. Working-age results cover adults 19 to 64. Sara R. Collins and colleagues wrote the report, "The State of Health Insurance Coverage in 2026," and the Fund says the increase in the uninsured rate is statistically significant.
Publication comes ten days before 2027 open enrollment opens on November 1 without the enhanced premium tax credits, which expired at the end of 2025, and as states prepare the Medicaid work requirements and six-month eligibility reviews that begin in 2027. It cites Congressional Budget Office estimates that federal policy changes will leave 37 million people uninsured by 2036, roughly the 2014 level.
Key Takeaways
- The working-age uninsured rate rose to 11.2% in 2026 from 8.9% in 2024, while employer coverage held at 58%.
- Marketplace and other individual-market coverage fell to 6.4% of working-age adults from 8.5%, and Medicaid to 13% from 15.5% in 2022.
- Among adults 19 to 34, the uninsured rate went from 11% to 16%, and their marketplace share from 7% to 5%.
- Of marketplace and individual enrollees insured all year, 51% were underinsured, against 29% with employer coverage and 20% on Medicaid.
- Half of working-age adults, 50%, reported a cost-related access problem in 2026, up from 46% in 2022, and nearly a third carried medical or dental debt.
Who left the marketplace and Medicaid
Two sources account for the coverage loss. Marketplace and other individual-market coverage fell to 6.4% of working-age adults from 8.5% in 2024, the report says, and Medicaid fell to 13% from 15.5% in 2022. Employer coverage was 57% in 2022, 57% in 2024 and 58% in 2026, so the employer market absorbed none of the decline. Exhibits in the report round the series to 9%, 9% and 11% uninsured across 2022, 2024 and 2026.
Losses were steepest in the two groups the report breaks out. Among adults 19 to 34, the uninsured rate rose from 11% in 2024 to 16% in 2026. Their marketplace and individual share fell from 7% to 5%, Medicaid from 20% in 2022 to 18% in 2024 and 17% in 2026, and employer coverage from 54% to 52%.
Among adults with incomes under 200% of the federal poverty level, $31,300 for an individual and $64,300 for a family of four, the uninsured rate rose from 14% to 17%. Their marketplace and individual share fell from 10% to 7%, and Medicaid from 28% in 2022 to 26% in 2024 and 24% in 2026. Employer coverage in the group edged up, from 33% to 34% to 35%.
| Coverage source, adults 19 to 64 | 2022 | 2024 | 2026 |
|---|---|---|---|
| Employer | 57% | 57% | 58% |
| Medicaid | 16% | 15% | 13% |
| Marketplace and other individual | 8% | 8% | 6% |
| Uninsured | 9% | 9% | 11% |
| Uninsured, ages 19 to 34 | n/a | 11% | 16% |
| Uninsured, under 200% FPL | n/a | 14% | 17% |
Source: Commonwealth Fund 2026 Biennial Health Insurance Survey exhibits, which round each series to whole percentages; the press release gives 8.9% to 11.2% for the uninsured rate, 8.5% to 6.4% for marketplace and individual coverage, and 15.5% to 13% for Medicaid.
For a marketplace pool, those are the two groups whose departure changes the average claim. Younger adults pay the lowest premiums under the ACA's 3-to-1 age band and tend to carry the lowest claims, so a pool that loses them ages and its average morbidity rises. Because the survey measures coverage, it cannot say how far the shift has moved claims. KFF's review of 2027 individual-market filings by 276 insurers found a median requested increase of about 15%.
Its field period ran from May to July 2026, after the enhanced credits expired and before the 2027 Medicaid changes, so the losses it records follow the first change and predate the second.
Underinsurance by coverage type
Inadequate insurance covered 46% of working-age adults in 2026, by the report's count. That figure combines the 11% uninsured at the time of the survey, 12% who were insured at the time but had a coverage gap in the prior 12 months, and 23% who were insured all year but underinsured.
The Fund defines underinsured as out-of-pocket costs, excluding premiums, of 10% or more of household income, or 5% or more for a household under 200% of poverty, or a deductible of 5% or more of income.
Among adults insured all year with the same type of coverage, 30% were underinsured. Rates were 29% for employer coverage, 20% for Medicaid and 38% for Medicare beneficiaries under 65. For marketplace and other individual coverage the rate was 51%, and for 39% of those enrollees the deductible alone exceeded 5% of income.
Cost and debt
Half of working-age adults, 50%, reported at least one cost-related access problem in 2026, up from 46% in 2022. Four problems count: not filling a prescription, skipping a test or treatment, not seeing a doctor when sick, or not getting specialist care, each because of cost.
For adults insured all year the rate was 40%, 42% and 43% across the three surveys, and for the uninsured 71%, 70% and 72%.
Nearly a third of working-age adults reported paying off medical or dental debt. That included 31% of adults with employer coverage all year and 33% of those with marketplace or individual coverage.
"The country is on the brink of undoing years of progress in health coverage," said Sara R. Collins, Commonwealth Fund senior scholar and vice president for expanding coverage and access and tracking health system performance, and the report's lead author. "Stripping insurance from millions of people will deepen an affordability crisis that already leaves too many going without care or paying off medical debt."
"Our survey shows that most Americans are struggling to get the health care they need, and things are getting worse," said Joseph R. Betancourt, M.D., the Fund's president.
What takes effect in 2027
Three policy changes the report points to are still ahead. Medicaid work requirements take effect in 2027, requiring 80 hours a month of work, school or volunteering, with eligibility reviews every six months. New marketplace restrictions apply from the same year. Enhanced premium tax credits expired on December 31, 2025, which restores the subsidy cliff at 400% of the federal poverty level.
Open enrollment for 2027 marketplace coverage runs from November 1, 2026 to January 15, 2027.
Further Reading
- ACA 2027 Rates Add a Second 4-Point Subsidy-Loss Morbidity Load: how 2027 filings price the enrollees expected to leave with the enhanced credits.
- Centene's Marketplace Book Shrank 41 Percent. Its Risk-Adjustment Position Swung Favorable With It: a carrier's own account of who left its marketplace pool.
- Medicaid Work Requirements 2027: Why CMS-2454-IFC Forces a Managed Care Capitation Reset: the capitation consequences of the 2027 eligibility rules.
- Medicaid Work Rule's 2.3M Exits Hit Self-Insured 2027 Assumptions: where the projected Medicaid exits land in employer plans.
Sources
- Commonwealth Fund press release, "New Survey: Uninsured Rate Climbs Even Before 2027 Medicaid Cuts Take Effect," October 22, 2026
- Collins, S. R., et al., "The State of Health Insurance Coverage in 2026: Findings from the Commonwealth Fund 2026 Biennial Health Insurance Survey," Commonwealth Fund, October 2026 (doi: 10.26099/e0eb-0g78)
- Commonwealth Fund, 2026 Biennial Health Insurance Survey exhibits (PDF)
- Healthcare Dive, "Uninsured rate rises ahead of Medicaid work requirements," October 27, 2026