Nearly half of American adults are underinsured or uninsured, survey finds

The number of working-aged adults in the U.S. who do not have adequate medical insurance or are not insured at all is rising, a new study reveals—and this is before Medicaid work requirements go into effect beginning in 2027.

New research from the Commonwealth Fund, a public health policy advocacy group, found that 46% of Americans aged 19 to 64 lacked adequate insurance, defined as being underinsured, having a coverage gap during the year—or being uninsured entirely, something that impacted 11% of all respondents to the Commonwealth Fund’s 2026 Biennial Health Insurance Survey.

In 2024, only 8.9% of adults reported being uninsured, meaning coverage rates have gotten worse over the last two years. Further, the number of adults who reported skipping necessary or routine care as a result of costs also rose from 46% in 2022 to now 50%.

The results are based on responses from a nationally representative sample of adults, taken between May 7 and July 20. This year, the Commonwealth Fund said 9,360 adults participated in the survey, though its analysis focused mostly on 7,362 responses.

As for explanatory factors for the reduction in insurance rates, the Commonwealth Fund said it can likely be attributed to federal policy, such as the sunsetting of expanded subsidies for health plans sold on Affordable Care Act markets, as well as cuts to Medicaid funding.

“Recent federal policy actions already appear to be taking a toll on people’s health coverage—ahead of major Medicaid cuts and other changes that are likely to trigger coverage losses for millions of Americans starting in 2027,” the group wrote. “This withdrawal of support for people’s health care runs counter to how most people feel about the role of the federal government in ensuring coverage for all Americans.”

Respondents seem to agree. According to the report, 73% of adults age 19 and older believe the “federal government has a responsibility to ensure all Americans have coverage,” especially Democrats and Independents.

Of them, respondents who identified as Democratic voters think the rising cost of insurance is a problem for the federal government to tackle at a rate of 93%. Seventy-six percent of independents agreed, followed by only 45% of Republicans.

“Congress and the executive branch have the tools to address the escalating affordability and coverage problems facing Americans,” the Commonwealth Fund wrote. “They can ensure everyone has good, affordable health insurance and health care.”

“The people we surveyed are signaling to policymakers that the federal government has a responsibility to do this.”

Young adults may be those struggling the most with the cost of premiums and copays—and finding a stable source of insurance, which for many is still linked to their place of employment. The Commonwealth Fund said its data shows uninsured rates for adults aged 19 to 34 rose, as did uninsured rates for all low-income working-aged adults, many of whom are young.

“Both groups experienced declines in ACA and Medicaid coverage,” the Commonwealth Fund said.