More Working-Age Adults Are Going Without Health Insurance

The share of working-age adults without health insurance has climbed over the past two years, driven in large part by the fact that many people can no longer afford Affordable Care Act plans after Congress let federal subsidies lapse at the end of last year.

According to a new Commonwealth Fund analysis, the uninsured rate among adults ages 19 to 64 rose to 11.2 percent this year from 8.9 percent in 2024. The Commonwealth Fund is a health policy and philanthropy nonprofit.

In the group’s biennial health insurance survey, nearly half of the 7,362 working-age adults who responded said they were uninsured, underinsured, or had experienced a coverage gap this year. Half also said they postponed or skipped medical care because of cost, up from 46 percent in 2022.

The enhanced premium tax credits had sharply reduced the price of Obamacare coverage, making it free or nearly free for some lower-income people. But the aid was intended as a temporary pandemic-era measure, and Congress allowed it to expire at the end of last year. Other federal subsidies remain available.

As those credits disappeared, the share of working-age adults with insurance through the Obamacare marketplaces, formally known as the Affordable Care Act exchanges, fell to 6 percent this year from 8 percent in 2024.

Enrollment in Medicaid among working-age adults also slipped, dropping to 13 percent this year from 16 percent in 2022, as many states removed people from their rolls after the COVID-19 pandemic.

The uninsured rate is likely to rise further once the Republican tax-and-spending law known as the One Big Beautiful Bill Act takes effect. The law will require many Medicaid recipients to show that they are working or taking part in approved community service for at least 80 hours each month.

It also requires states to recheck Medicaid eligibility every six months.

A separate reason more people are losing coverage is the rising cost of healthcare, which is pushing private insurance premiums higher.

“It’s affecting people’s ability to pay off bills right away, and it’s having an effect on health plans,” said Sara Collins, a senior scholar at the Commonwealth Fund and the report’s lead author.

Nearly one-third of survey respondents, whether insured or uninsured, said they currently had medical or dental bills or were paying down medical debt. More than 70 percent of uninsured adults said cost had caused problems getting care.

“I think it’s very concerning,” Collins said. “We know from our survey data that not going to get care isn’t and just generally is not good for people’s health over the long run.”

The increase in the uninsured rate follows a lengthy period of improvement. Between 2010 and 2025, the overall uninsured rate in the United States was cut in half, falling to 8 percent from nearly 16 percent, largely because of the Affordable Care Act.