The uninsured rate has climbed over the past two years as Medicaid work requirements—which are expected to drive their own coverage losses—loom at the beginning of 2027.
Researchers at the Commonwealth Fund found that the uninsured rate in 2026 was 11.2% in 2026, up from 8.9%. The findings come from the fund’s biennial Health Insurance Survey, which polled a nationally representative sample of 9,360 adults, between May 7 and July 20.
The analysts note that the spike aligns with the expiration of the enhanced premium tax credits for Affordable Care Act marketplace plans, as well as the end of another post-COVID policy that made it easier for individuals to maintain their Medicaid coverage. And it comes in advance of the work requirements rollout alongside further changes to the exchanges that are incoming.
Sara Collins, Commonwealth Fund senior scholar and the study’s lead author, told Fierce Healthcare that estimates from the Congressional Budget Office project that these policy changes will play a key role in increasing the number of uninsured people by 11 million by 2036, reaching a total of about 37 million.
One of the core principles of the Affordable Care Act was to significantly increase coverage, leading to the creation of the insurance exchanges as well as Medicaid expansion. More recent policy changes, like those included in H.R. 1, fly in the face of that goal, Collins said.
“The expansions in the Affordable Care Act are there for a reason,” she said. “They filled big gaps in our health insurance system, they have enabled the country to increase the number of people to have heath coverage.”
“These federal policy changes will reverse that progress,” Collins said.
In addition, the study highlights that challenges in affording and accessing healthcare aren’t limited to just people without coverage. Half of the adults surveyed said that they had gone without necessary medical services due to the cost, rising from 46% of people who said the same in 2022.
This includes skipping on a test or treatment, not picking up a prescription, avoiding a doctor’s visit when sick or not seeking specialty care, according to the report.
“It’s a tsunami, really, of problems that we’re seeing,” Collins said.
The Commonwealth Fund report does include several policy recommendations that regulators and lawmakers could pursue to address the declines in coverage. The suggestions start with reversing course on sunsetting the post-COVID premium tax credits for ACA plans, as well as the plans to drastically expand the Medicaid work requirements.
In addition, stakeholders could consider establishing a federal coverage option that would be available in states that did not expand Medicaid, where individuals are automatically enrolled to ensure they’re covered, per the study. Eliminating deductibles from commercial coverage and preventing medical debt from appearing on credit reports could support easier affordability, the researchers said.
And as costs rise, people increasingly expect policymakers to step in. About three-quarters of those surveyed said they believe the federal government should ensure that everyone is covered. This was a view shared by 93% of Democrats, 76% of independents and 45% of Republicans.
“What’s striking about it is that federal policy is going in the opposite direction,” Collins said. “It is directionally opposite in terms of what people are expecting. I think that is a message that a lot of policymakers may pick up on.”