U.S. Health Coverage in 2026: The Uninsured Rate Is Rising Again. Here's the Data.

A historic low, followed by a reversal already underway

The U.S. uninsured rate reached its lowest point in recorded history in early 2023, at roughly 7.7-7.9%, the product of ACA marketplace subsidy enhancements, continuous Medicaid enrollment protections carried over from the pandemic, and sustained enrollment outreach. That progress has already started reversing. By 2025, the uninsured rate had ticked up to 8.3%, an estimated 28 million people, up from 27.2 million in 2024.

The reversal is expected to accelerate further. Enhanced ACA premium subsidies, which had been offsetting costs for roughly 22 million enrollees, expired at the end of 2025. According to KFF, this is expected to push premiums up by an average of 114% for affected enrollees and reduce marketplace enrollment by roughly 5 million people in 2026 alone. Separately, the Congressional Budget Office estimates that Medicaid changes enacted in 2025 federal budget legislation could add another 10 million people to the uninsured rolls over the next decade.

Why this varies so dramatically by state

Coverage rates diverge sharply depending on whether a state expanded Medicaid under the ACA. In 2025, adults in non-expansion states were more than twice as likely to be uninsured as those in expansion states, 18.1% versus 9%. Texas, a non-expansion state, has the nation's highest uninsured rate at 16.7% overall and 21.6% among working-age adults specifically, and accounts for an estimated 42% of the national "coverage gap": people who earn too much to qualify for Medicaid in their state but too little to qualify for ACA marketplace subsidies.

This coverage gap, roughly 1.4 million people nationally, exists specifically because of the patchwork of state-by-state Medicaid expansion decisions following the ACA's passage, and remains one of the more consequential, if less discussed, structural features of the American healthcare system.

Who is actually uninsured, by the numbers

• Adults ages 18-64 remain the group most likely to lack coverage, at 11.6% uninsured, accounting for roughly 23.5 million of the 28 million total uninsured
• Seniors 65 and older are nearly universally covered at just 0.7% uninsured, reflecting Medicare's near-total reach for that age group
• Children's uninsured rate rose to 5.6% in 2025 from 5.1% in 2024, though the CDC noted the change was not statistically significant on its own
• Hispanic adults face a notably higher uninsured rate than the national average, though that rate has fallen substantially, from 30.1% five years ago to 21.9% in 2025
• Cost remains the dominant reason people lack coverage: 63.2% of uninsured adults cite affordability as the primary barrier, according to KFF

The core disagreement beneath the coverage numbers

Supporters of expanding ACA subsidies and Medicaid argue the 2023 low-water mark for the uninsured rate proves that direct subsidy and eligibility expansion measurably works, and that allowing subsidies to lapse predictably reverses that progress. Critics of continued subsidy expansion generally argue that the enhanced subsidies were always meant as temporary, pandemic-era measures, and that permanent extension raises long-term federal spending and deficit concerns that need to be weighed against coverage gains.

A separate, less partisan strand of the debate focuses specifically on the non-expansion state coverage gap, since that specific group, people who fall between Medicaid and marketplace eligibility, is one that even many marketplace-subsidy skeptics acknowledge as a genuine structural gap in the current system, distinct from the broader subsidy debate.