The nation’s uninsured rate held at 8% in 2025, matching a historic low, but health researchers and the Congressional Budget Office project that figure is about to climb sharply as expired insurance subsidies and new Medicaid eligibility rules begin taking effect throughout 2026.
What Happened
National survey data released this year showed the all-ages uninsured rate remained steady at 8% in 2025, a level significantly lower than a decade earlier, but health policy researchers warned the figure would soon begin rising as sweeping changes to the health insurance landscape took hold. The nonpartisan Congressional Budget Office projects the number of uninsured Americans will increase by 3.4 million in 2026 compared with 2025, followed by additional increases of 7.5 million in 2027 and 8.7 million in 2028, pushing the total uninsured population above 35 million by 2028, a 33% increase from 2025 levels.
The healthcare research nonprofit KFF estimates roughly 5 million fewer people will enroll in Affordable Care Act marketplace plans in 2026 compared with the prior year, driven substantially by the expiration of enhanced premium tax credits that had helped offset premium costs for millions of enrollees since 2021. Separately, changes to Medicaid enacted through last year’s budget reconciliation law are projected by the CBO to reduce Medicaid expansion enrollment significantly over the coming decade.
Combined, CBO projects that changes to the Affordable Care Act’s tax credits and Medicaid expansion together will reduce the number of Americans helped by those programs by 16.5 million between 2025 and 2032, a 44% decrease, though not everyone losing that specific assistance will become fully uninsured, since some will find coverage through other channels.
Why It Matters
The scale of the projected coverage loss would represent one of the most significant reversals in US health insurance history, given that the uninsured rate had fallen dramatically since the Affordable Care Act’s major coverage expansions took effect in 2014, when 44 to 46 million Americans, roughly 16% to 17% of the nonelderly population, lacked insurance. Even after the projected increases, current levels would remain well below that pre-ACA peak, though the gap is expected to narrow considerably.
Being uninsured carries well-documented health and financial consequences, including delayed care for treatable conditions, higher rates of medical debt, and worse health outcomes overall, meaning the projected increase carries direct implications for millions of American families’ access to care and financial stability, independent of any broader political debate over the policy changes driving it.
The Urban Institute has separately projected that the number of uninsured Black Americans specifically will increase by 30%, or roughly 925,000 people, in 2026, the largest rate of increase among racial and ethnic groups, highlighting how the coverage changes are likely to affect different communities unevenly rather than uniformly across the population.
Context and Background
The enhanced premium tax credits set to expire were first implemented in 2021 and had helped an estimated 20 million Americans afford marketplace insurance premiums, contributing significantly to the historically low uninsured rates recorded in recent years. Without an extension, the Center on Budget and Policy Priorities projects that a single individual earning $22,000 annually, roughly 140% of the poverty level, would see their monthly marketplace premium rise from $0 to $66, an annual increase of $786.
Separately, the budget reconciliation law signed by President Trump last year, formally known as H.R. 1, implemented significant changes to Medicaid eligibility and funding structures, changes the CBO projects will reduce Medicaid enrollment by 7.5 million and marketplace enrollment by 2.1 million over the next decade when combined with the expiring subsidies.
Insurance regulators in multiple states have already approved or proposed substantial premium increases for 2026 marketplace plans, with some insurers requesting rate hikes exceeding 30% to 60% in certain states, reflecting insurers’ own expectations that a smaller, comparatively less healthy pool of remaining enrollees will require higher premiums to sustain coverage.
Expert Analysis
Health policy researchers note that the projected coverage losses reflect the combined effect of multiple simultaneous policy changes, expiring subsidies, new Medicaid eligibility rules, and reduced federal outreach and enrollment support, rather than any single factor, making the overall scale of the impact more significant than any one change would produce in isolation.
Economists studying insurance markets caution that reduced enrollment, particularly if it disproportionately affects younger and healthier individuals who may find coverage less affordable without subsidies, risks triggering a self-reinforcing cycle in which shrinking, sicker risk pools drive premiums even higher for those who remain enrolled, a dynamic insurance analysts commonly refer to as a market “death spiral.”
Public health experts emphasize that the consequences of rising uninsurance extend beyond the directly affected individuals, since increased uncompensated care costs at hospitals and clinics tend to be absorbed across the broader healthcare system, potentially affecting costs and access even for people who retain insurance coverage.
What Happens Next
Enrollment data for 2026 marketplace plans, expected to be finalized in the coming months, will offer the first concrete confirmation of how closely actual coverage losses track the CBO’s projections. Congressional action to extend the expired enhanced subsidies remains a possibility, though no such extension had been enacted as of the most recent policy updates.
Given the multi-year trajectory built into current law, further increases in the uninsured rate are expected to continue through 2028 and beyond absent legislative changes, making the issue likely to remain a significant and closely tracked point of ongoing healthcare policy debate.
