Rising Uninsured Rate Amidst Expiration of Federal Subsidies

The proportion of U.S. adults aged 19 to 64 without health insurance has increased over the past two years, largely due to the expiration of pandemic-era federal subsidies that had made Affordable Care Act (ACA) coverage more affordable.

This trend was highlighted in a recent analysis by the Commonwealth Fund, revealing an uninsured rate of 11.2% for this demographic in the current year, rising from 8.9% in 2024. The cessation of temporary subsidies—initially introduced to alleviate the financial burdens of healthcare during the pandemic—has significantly impacted the cost and accessibility of ACA marketplace plans. As these subsidies faded at the end of last year, the proportion of working-age adults using ACA marketplace plans dropped from 8% in 2024 to 6% this year.

Impact on Medicaid Enrollment

In addition to marketplace plans, Medicaid coverage among working-age adults has also seen a decline. The percentage of adults enrolled in Medicaid has decreased from 16% in 2022 to 13% this year, coinciding with state-driven efforts to remove individuals from Medicaid rolls post-pandemic.

The upcoming implementation of the One Big Beautiful Bill Act in January may exacerbate the situation. This legislation will introduce new eligibility requirements for Medicaid recipients, including proof of employment or community service and biannual eligibility verifications, potentially further shrinking coverage.

Cost Barriers and Medical Debt

The rising uninsured rate is compounded by escalating healthcare costs, which are driving up premiums for private insurance plans. According to Sara Collins, a senior scholar at the Commonwealth Fund, the financial strain is affecting individuals' abilities to manage bills and is impacting health plans.

A striking 50% of the survey's 7,362 adult participants reported delaying or avoiding medical treatment this year due to cost concerns, up from 46% in 2022. Furthermore, nearly a third of respondents, regardless of insurance status, reported having medical or dental bills or existing medical debt.

"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."
Sara Collins, The Commonwealth Fund

Historical Context and Future Implications

This recent uptick follows a decade of overall improvements in uninsured rates across the U.S. The ACA initially helped decrease the uninsured rate from nearly 16% in 2010 to 8% by 2025. However, the latest analysis suggests that these gains might be jeopardized due to policy changes and cost pressures.

The insurance industry must closely monitor how current and upcoming legislation will further influence coverage dynamics. Stakeholders, including insurance carriers, brokers, and compliance teams, need to be aware of these changes and their potential impacts on plan offerings and market strategies. Adjusting to these evolving circumstances will be essential for maintaining coverage levels and addressing the nationwide challenges in access to healthcare.