The data: The uninsured rate among working-age adults rose from 8.9% in 2024 to 11.2% in 2026, according to newly released Commonwealth Fund survey data. The survey polled 9,360 US adults ages 19 and older from May 7 to July 20. Uninsured rates rose more sharply among adults ages 19 to 34 (from 11% to 16%) and those with household incomes below 200% of the federal poverty level (from 14% to 17%).

Zooming out: The Commonwealth Fund attributes declining coverage rates to the Trump administration and congressional policy changes.

• The share of working-age adults with Affordable Care Act (ACA) marketplace and individual market coverage fell from 8.5% in 2024 to 6.4% in 2026. The share with Medicaid enrollment also fell, from 15% in 2024 to 13% in 2026.
• The declines follow the end of pandemic-era Medicaid protections and enhanced ACA premium tax credits. Those credits helped nearly double marketplace enrollment between 2020 and 2025.

The uninsured rate underestimates the problem: 46% of working-age adults lacked adequate coverage in 2026. Beyond the 11% who were uninsured, 12% experienced a coverage gap and 23% were underinsured, meaning their deductibles or out-of-pocket costs were high relative to their income. Among adults with marketplace coverage, 51% were underinsured, reflecting a shift toward higher-deductible plans that leave members paying for most of their medical costs until they reach their annual deductible.

Why it matters: The Commonwealth Fund offers one of the first credible looks at how federal and state eligibility policy changes could erode some of the coverage gains made since the ACA passed. The ACA helped halve the uninsured rate from nearly 16% in 2010 to 8% in 2025. But the Commonwealth Fund projects that recent policy changes, including stricter Medicaid work requirements and more frequent eligibility checks taking effect next year, will push the uninsured population to 37 million by 2036, roughly its 2014 level.

More Americans risk becoming uninsured or underinsured, compounding existing healthcare affordability challenges.

• 50% of all respondents skipped needed or recommended care or treatment due to cost in the past year, up from 48% in 2024, per the Commonwealth Fund.
• Among uninsured adults, that share rose to 72%, from 70%.
• 59% of those with insurance all year but underinsured avoided needed or routine care or treatment due to cost.

Implications for the healthcare marketers: Healthcare affordability could become a flashpoint ahead of next week’s midterms. These new findings give voters (who already cite healthcare costs as their top financial worry) a tangible measure of how shifting healthcare policies are affecting insurance access and costs.

For healthcare marketers, affordability concerns extend beyond uninsured patients. Many insured consumers face high out-of-pocket costs until they meet their deductibles, prompting them to shop for care based on price. Providers and online healthcare companies should show patients what they can expect to pay before meeting their deductible and promote payment plans and financial assistance at key decision points, from appointment scheduling to treatment selection.