The Uninsured Rate Is Rising: What the 11.2% Figure Means for Clinical Practice

An analysis for physicians by Sanjar Odilov, Credentialing Department, WCH

The Headline Number, and What It Actually Measures

The Commonwealth Fund’s 2026 Biennial Health Insurance Survey reports that the uninsured rate among working-age Americans rose to 11.2% in 2026, up from 8.9% in 2024. The sample was 9,360 US adults surveyed from May 7 to July 20.

Two details matter for interpretation. First, the figure covers adults aged 19-64, not the whole population. Second, it is easy to confuse with federal data. The CDC’s National Health Interview Survey put the 2025 uninsured rate at 8.3% across all age groups. The two figures use different populations and methods, so the gap between them is not a measure of one year’s change. The cleaner comparison is the Commonwealth Fund’s own 8.9% to 11.2%, which the AJMC describes as statistically significant.

The rise also follows a long period of improvement. Between 2010 and 2025, the overall US uninsured rate fell by half, from nearly 16% to 8%, largely because of the Affordable Care Act.

Where the Coverage Was Lost

According to the survey, ACA marketplace and individual market coverage fell from 8.5% of working-age adults in 2024 to 6.4% in 2026, and Medicaid coverage declined from 15.5% in 2022 to 13%. The authors link this to the expiration of the enhanced premium tax credits, which raised average annual premiums by amounts ranging from $750 to $4,035, depending on income, and to declining Medicaid enrollment.

The losses are uneven. Uninsured rates rose more sharply among adults aged 19 to 34 (from 11% to 16%) and among those with household incomes below 200% of the federal poverty level (from 14% to 17%). For clinicians, this means the patients most likely to be affected are young adults and lower-income patients, groups that often use care episodically and may not raise coverage problems unprompted.

Uninsurance Is Only Part of the Problem

The survey’s broader finding may matter more clinically than the headline. 46% of working-age adults were inadequately insured: 11% were uninsured, 12% had a coverage gap during the year, and 23% were underinsured, meaning they had coverage but their plan did not provide affordable access to care.

The survey defines underinsurance by cost burden: medical bills excluding premiums reaching 10% of household income (5% for those below twice the poverty line), or a deductible alone reaching 5% of income.

The behavioral consequence is already visible. The share of adults delaying or avoiding care because of cost reached 50% in 2026, up from 46% in 2022. Lead author Sara Collins said that going without care is generally bad for people’s health over time (paraphrased from her comments to Stateline).

What May Come Next

The authors describe these results as a baseline, not a peak. The survey was fielded before the major provisions of the 2025 reconciliation law (H.R. 1, the “One Big Beautiful Bill Act”) take effect. Medicaid work requirements are expected to start at the beginning of 2027 and to drive their own coverage losses. The Congressional Budget Office projects that the law’s Medicaid and marketplace changes will result in 10.9 million more uninsured Americans by 2034.

Whether and how fast this materializes depends on state implementation and on future legislative action. Projections are not observed outcomes.

Practical Implications for the Clinic and the Hospital

The following are suggestions based on the survey’s findings, not recommendations from the Commonwealth Fund.

Ask about coverage and cost, not just diagnosis. If half of working-age adults skip care because of cost, a plan that depends on an expensive test, specialist referral, or brand-name drug may simply not be carried out.

Flag coverage transitions. A patient who lost Medicaid or marketplace coverage in the past year may be in a gap and may not say so. Build coverage status into rooming or pre-visit workflows.

Prescribe with price in mind. Generics, lower-cost alternatives, and 90-day supplies reduce the chance of non-adherence in chronic disease management.

Connect patients with navigators and financial counselors. Marketplace enrollment help, Medicaid redetermination support, and hospital financial assistance programs can matter as much as the clinical plan.

Anticipate payer-mix shifts. For practice and hospital leaders, rising uninsurance and underinsurance mean more self-pay and more uncompensated care. The survey’s authors note that some of those losing marketplace coverage are shifting to employer plans, where underinsurance is also significant.

Document cost-related barriers. Recording that a patient deferred care for financial reasons helps with care coordination and supports the data needed for policy and resource planning.

Limitations: This is a self-reported, cross-sectional survey, so it measures coverage at the time of fielding and is subject to the usual limits of survey research. Its figures differ from federal estimates in population and method, and the survey predates the largest anticipated policy changes. The trend is consistent across sources, but the exact size of future changes is uncertain.

Sources