Roughly 27.2 million Americans were uninsured in 2024, the most recent confirmed year of federal data, and that number is projected to climb toward 30 million in 2026 after the ACA’s enhanced premium tax credits expired at the end of 2025. The national uninsured rate sits at 8.2%, the first increase since 2019, and early 2026 marketplace data already shows enrollment falling for the first time in seven years.
Americans Without Health Insurance 2026 – Introduction
Americans Without Health Insurance in 2026 make up a group that had been shrinking for most of the past decade, until it wasn’t anymore. The uninsured rate hit a record low below 9% in 2023, the payoff of years of ACA marketplace growth and pandemic-era Medicaid protections. That progress reversed in 2024, when the uninsured count rose for the first time since 2019, and 2025 brought no relief, with the total climbing again even as the rate held roughly flat. Now 2026 is shaping up to be the sharpest reversal yet, driven by a single policy change: the enhanced premium tax credits that made ACA marketplace plans affordable for millions expired on December 31, 2025, and Congress didn’t act to extend them.
The fallout is already visible in the data. Average marketplace premium payments jumped 58% in early 2026, deductibles hit a record high, and marketplace plan selections fell for the first time in seven years, dropping from 24.3 million to 23.1 million people. Coverage isn’t disappearing evenly across the country, either. States that never expanded Medicaid, Texas most of all, carry a wildly disproportionate share of the uninsured, and Hispanic adults remain uninsured at nearly three times the rate of white adults. The sections below break down exactly who’s losing coverage in 2026, where they live, and why.
AMERICANS WITHOUT HEALTH INSURANCE 2026 — QUICK SNAPSHOT
Uninsured (2024, confirmed) ........ 27.2 million (8.2%)
Uninsured (2026, projected) ........ ~28-30 million
Highest State Uninsured Rate ........ Texas, 16.7%
Lowest State Uninsured Rate ......... Massachusetts, 2.8%
ACA Marketplace Enrollment 2026 ..... 23.1 million (-4.9%)
Avg. Premium Increase (net, 2026) ... +58%
Interesting Facts About Americans Without Health Insurance 2026
| Fact | Data Point |
|---|---|
| Total Uninsured (2024, confirmed) | 27.2 million, 8.2% of the population |
| First Increase Since | 2019 |
| Highest State Rate | Texas, 16.7% |
| Lowest State Rate | Massachusetts, 2.8% |
| Non-Expansion States’ Share of Uninsured | 42%, despite only 28% of the population |
| Hispanic Adult Uninsured Rate | 24.6% |
| ACA Marketplace Enrollment 2026 | 23.1 million, down 4.9% from 2025 |
| Avg. Subsidized Premium Increase | +58% net of tax credits |
| Children Uninsured Rate | 5.1%, up from 3.9% in 2023 |
| Americans Carrying Medical Debt | ~100 million, 41% of adults |
Americans Without Health Insurance statistics for 2026 point to a system under real strain for the first time in years. The uninsured count rose by roughly 1.3 million between 2023 and 2024, the first increase since the pandemic, and 2025 added another 800,000 uninsured people even while the overall rate held near 8%. That’s before accounting for the ACA subsidy cliff, which the Congressional Budget Office estimates will push the uninsured population up by another 2.2 million in 2026 on its own, with broader estimates factoring in Medicaid policy changes putting the total closer to 30 million.
The geographic and demographic split remains just as stark as ever. Ten states, led by Texas at 16.7% uninsured, never expanded Medicaid under the ACA, and those ten states alone account for 42% of the country’s entire uninsured population while holding only 28% of its residents. Layer the marketplace subsidy expiration on top of that divide, and 2026 is set to widen a gap that had been narrowing for over a decade.
Americans Without Health Insurance 2026: National Rate and Historical Trend
US UNINSURED RATE BY YEAR (2010-2026)
2010 |################### 18.2%
2019 |########### 10.9%
2023 |######## 8.9% (record low)
2024 |######### 8.2%
2025 |######### 8.0% (est.)
2026 |########## 8.5-9.5% (projected)
| Year | Uninsured Rate | Uninsured Total |
|---|---|---|
| 2010 | 18.2% | 48.2 million |
| 2019 | 10.9% | ~28.9 million |
| 2023 | 8.9% | 26.4 million (record low) |
| 2024 | 8.2% | 27.2 million |
| 2025 (estimate) | ~8.0% | ~28.0 million |
| 2026 (projected) | 8.5%-9.5% | 28-30 million |
Source: U.S. Census Bureau, American Community Survey; CDC National Center for Health Statistics; Congressional Budget Office projections
The uninsured rate fell from over 18% in 2010 to under 9% by 2023, one of the largest sustained coverage gains in modern U.S. history, driven by the ACA’s Medicaid expansion and marketplace subsidies. That trend broke in 2024. The uninsured count rose by about 1.3 million people, the first increase since 2019, and 2025 data shows the total climbing again, adding roughly 800,000 more uninsured Americans, 300,000 of them children, even as the overall rate stayed close to 8%.
The 2026 figures in this table are projections, not confirmed government releases, since final annual uninsured totals typically post 12 to 18 months after the calendar year ends. But the direction is not in dispute. The CBO projects the uninsured population will grow by roughly 2.2 million in 2026 specifically because of the expired ACA subsidies, and broader estimates that also account for Medicaid eligibility changes put total 2026 uninsured Americans as high as 30 million, a level not seen since before the pandemic.
Americans Without Health Insurance by State 2026
UNINSURED RATE: HIGHEST VS LOWEST STATES 2026
Texas |################### 16.7%
Oklahoma |############### 14.3%
Georgia |############## 13.4%
---
New York |#### 4.9%
Hawaii |#### 3.9%
Massachusetts |## 2.8%
| State | Uninsured Rate | Rank |
|---|---|---|
| Texas | 16.7% | Highest in the U.S. |
| Oklahoma | ~14.3% | 2nd highest |
| Georgia | ~13.4% | Among highest |
| National Average | 8.2% | — |
| New York | ~4.9% | Among lowest |
| Hawaii | ~3.9% | 2nd lowest |
| Massachusetts | 2.8% | Lowest in the U.S. |
Source: U.S. Census Bureau, American Community Survey 1-Year Estimates (2024)
Texas has held the title of the state with the highest uninsured rate for years running, and the gap between Texas and the rest of the country is not narrowing. At 16.7%, Texas’s uninsured rate is more than double the national average and nearly six times higher than Massachusetts, which sits at 2.8% thanks to a state health reform law that predates the ACA by nearly a decade. Texas alone holds roughly 588,000 people stuck in the coverage gap, low-income adults who earn too much for traditional Medicaid but too little to qualify for marketplace subsidies, which by itself accounts for 42% of the entire nation’s coverage gap population.
The pattern across most high-uninsured states is the same: no Medicaid expansion, a large low-income population, and heavy reliance on the ACA marketplace for anyone who doesn’t get coverage through a job. That reliance makes states like Texas, Florida, and Georgia especially exposed to the 2026 subsidy expiration, since marketplace enrollees in non-expansion states have fewer fallback options than residents of expansion states, where Medicaid remains available as a safety net regardless of what happens to federal marketplace subsidies.
Uninsured Americans by Race and Ethnicity 2026
UNINSURED RATE BY RACE/ETHNICITY 2026 (Ages 18-64)
Hispanic |######################## 24.6%
Black |########## 10.5%
White |######## 7.9%
Asian |##### 5.4%
| Race / Ethnicity | Uninsured Rate (Ages 18-64) | Trend Since 2020 |
|---|---|---|
| Hispanic | 24.6% | Down slightly, still highest |
| Black, non-Hispanic | 10.5% | Down from 14.6% (-28%) |
| White, non-Hispanic | 7.9% | Roughly stable |
| Asian, non-Hispanic | 5.4% | Lowest of major groups |
Source: CDC National Center for Health Statistics, National Health Interview Survey (2024)
Hispanic adults remain uninsured at nearly three times the rate of white adults, a gap that has persisted for as long as federal agencies have tracked it. Almost one in four Hispanic adults ages 18 to 64 lacked coverage in 2024, driven by a combination of lower rates of employer-sponsored insurance, immigration status barriers to public programs, and disproportionate representation in states that never expanded Medicaid. Black non-Hispanic adults, by contrast, have seen real, sustained progress: their uninsured rate dropped 28% between 2020 and 2024, from 14.6% down to 10.5%, one of the sharpest improvements of any demographic group tracked by the CDC.
Asian non-Hispanic adults post the lowest uninsured rate of any major racial or ethnic group at 5.4%, while white non-Hispanic adults sit close to the national average at 7.9%. These gaps aren’t just about individual choices or employer benefits; they trace directly back to where these populations live. Hispanic and Black adults are overrepresented in the South, where non-expansion states concentrate the country’s highest uninsured rates, meaning geography and race compound each other in shaping who has coverage and who doesn’t.
Uninsured Children and Young Adults Statistics 2026
UNINSURED RATE BY AGE GROUP 2026
Children (under 18) |##### 5.1%
Young Adults (19-25) |############## 14.1%
Working Age (18-64) |########### 11.6%
| Age Group | Uninsured Rate | Trend |
|---|---|---|
| Children (under 18) | 5.1% (3.7 million) | Up from 3.9% in 2023 |
| Young Adults (19-25) | ~14.1% | Highest of any age bracket |
| Working-Age Adults (18-64) | 11.6% | Roughly stable since 2024 |
Source: CDC National Center for Health Statistics, National Health Interview Survey (2024)
Children had been one of the ACA’s clearest success stories, with uninsured rates among kids sitting near historic lows for most of the past five years. That streak broke in 2024. The child uninsured rate jumped from 3.9% to 5.1% in a single year, pushing the number of uninsured children to 3.7 million, even though children’s coverage options through Medicaid and CHIP remained largely unchanged. Researchers point to Medicaid redetermination processes, the post-pandemic “unwinding” that resumed eligibility checks states had paused for three years, as a likely driver, since procedural disenrollments often catch eligible children whose parents miss a renewal deadline.
Young adults, meanwhile, remain the single most likely age group to lack coverage at any point in their lives, with an uninsured rate around 14.1%, well above both children and older working-age adults. This age group sits in an awkward gap: too old in many cases to stay on a parent’s plan, often working entry-level or gig jobs that don’t offer employer coverage, and young enough that marketplace premiums, even discounted ones, can feel like an unnecessary expense until something goes wrong.
Medicaid Expansion vs Non-Expansion States 2026
UNINSURED RATE: EXPANSION VS NON-EXPANSION STATES 2026
Expansion States (41 + DC) |######### 9.3%
Non-Expansion States (10) |################# 17.4%
| State Category | Uninsured Rate (18-64) | Share of U.S. Population | Share of Uninsured |
|---|---|---|---|
| Medicaid Expansion States (41 + DC) | 9.3% | 72% | 58% |
| Non-Expansion States (10) | 17.4% | 28% | 42% |
Source: CDC National Center for Health Statistics; MoneyGeek analysis of Census Bureau data
The single clearest predictor of whether someone has health insurance in America isn’t their income or their job, it’s which state they live in. Adults in the ten states that never expanded Medicaid under the ACA, Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming, are uninsured at nearly double the rate of adults in expansion states, 17.4% compared to 9.3%. For more context on how overall coverage is distributed across the private and public system nationwide, the Health Insurance Coverage in the U.S report breaks down exactly how private and public insurance combine to cover roughly 92% of Americans.
That ten-state divide has held steady for over a decade, and 2026’s ACA subsidy expiration is likely to widen it further rather than close it. Expansion-state residents who lose marketplace subsidies still have Medicaid as a fallback if their income drops low enough; non-expansion-state residents in the same situation simply become uninsured, since they were never eligible for expanded Medicaid to begin with. That structural gap is why the same ten states keep showing up at the top of every uninsured-rate ranking, year after year, regardless of what else changes in the broader economy.
ACA Subsidy Expiration 2026: Premiums, Enrollment and Coverage Loss
ACA MARKETPLACE IMPACT: SUBSIDY EXPIRATION 2026
2025 Enrollment |############################## 24.3M
2026 Enrollment |############################ 23.1M (-4.9%)
Avg Premium (net) |$113 → $178 (+58%)
Avg Deductible |+37% to record $3,786
| Metric | 2025 | 2026 | Change |
|---|---|---|---|
| Marketplace Plan Selections | 24.3 million | 23.1 million | -4.9% |
| Avg. Monthly Premium (net of subsidy) | $113 | $178 | +58% |
| Avg. Marketplace Deductible | ~$2,759 | $3,786 | +37% |
| Share Receiving Any Tax Credit | 93% | 87% | -6 points |
Source: KFF Affordable Care Act Tracker; CMS Health Insurance Exchanges 2026 Open Enrollment Report
The enhanced ACA premium tax credits that Congress first authorized in 2021 and extended through 2025 expired on December 31 with no renewal, and the effects showed up almost immediately. For a broader statistical breakdown of exactly how marketplace plan selection, subsidy loss, and premium data shifted this year, the ACA Marketplace Statistics in US report tracks the full open enrollment numbers straight from CMS. Nationwide plan selections fell to 23.1 million from a record 24.3 million the year before, the first decline in seven years, and average out-of-pocket premium payments net of subsidies rose 58%, from $113 to $178 a month.
The people hit hardest are middle-income households who earned just over 400% of the federal poverty level, the income cap where subsidy eligibility used to phase out gradually and now ends abruptly. KFF estimates that subsidized enrollees trying to keep their exact same plan would see payments more than double on average, a projected 114% increase worth roughly $1,016 a year, and average marketplace deductibles jumped 37% to a record $3,786 per person as many households traded down to cheaper, higher-deductible bronze plans just to keep their monthly premium manageable.
Health Insurance Coverage Type Statistics 2026: Private, Public and Marketplace Plans
HEALTH INSURANCE COVERAGE BY TYPE 2026 (Under 65)
Private Insurance |################## 65.4%
Public Insurance |####### 26.6%
Marketplace/Exchange |## 5.7%
Uninsured |### 9.8%
| Coverage Type | Share of Population (Under 65) | Trend |
|---|---|---|
| Private Insurance | 65.4% | Slightly up since 2020 |
| Public Insurance (Medicaid/Medicare) | 26.6% | Declining since Medicaid unwinding |
| Marketplace/Exchange Plans | 5.7% | Up from 3.8% in 2020, now falling in 2026 |
| Uninsured | 9.8% | First rise since 2019 |
Source: CDC National Center for Health Statistics, National Health Interview Survey (2024)
Private insurance, mostly through an employer, still covers roughly two-thirds of Americans under 65, while public programs like Medicaid and Medicare cover just over a quarter. The marketplace-specific share more than doubled between 2020 and 2024, climbing from 3.8% to 5.7% of the population, entirely a product of the enhanced subsidies that made exchange plans dramatically cheaper for millions of households during that stretch. Losing coverage, whatever the cause, carries consequences well beyond the insurance card itself; the Medical Debt Statistics & Forgiveness Trends in the US report shows that roughly 100 million Americans, both insured and uninsured, now carry some form of medical debt, with people uninsured for even part of the year carrying debt at nearly double the rate of those insured all year.
That marketplace growth is now reversing in real time. With enhanced subsidies gone, exchange plan selections dropped for the first time since 2020, and public coverage has been shrinking too, driven by the post-pandemic Medicaid unwinding that resumed eligibility checks after a three-year continuous-enrollment pause. The combination of a shrinking marketplace and a shrinking Medicaid rolls, without a matching surge in employer coverage to absorb the difference, is exactly the mechanism driving the uninsured rate back up after a decade of steady declines.
Frequently Asked Questions About Americans Without Health Insurance 2026
How many Americans don’t have health insurance in 2026?
The most recent confirmed figure is 27.2 million Americans uninsured in 2024, an 8.2% rate. Projections for 2026, factoring in the ACA subsidy expiration, put the total between 28 and 30 million.
Why did the uninsured rate go up in 2024 and 2025?
The uninsured rate rose for the first time since 2019 because of two overlapping trends: the post-pandemic Medicaid “unwinding,” which resumed eligibility checks that had been paused for three years, and slowing growth in ACA marketplace enrollment ahead of the 2026 subsidy expiration.
What happened to ACA subsidies in 2026?
The enhanced premium tax credits established in 2021 and extended through 2025 expired on December 31, 2025, and Congress did not renew them. Average subsidized premium payments rose 58% in early 2026 as a result, with further increases expected for households trying to keep the same plan.
Which state has the highest uninsured rate?
Texas has the highest uninsured rate in the country at 16.7%, a position it has held for years due to not expanding Medicaid under the ACA.
Which state has the lowest uninsured rate?
Massachusetts has the lowest uninsured rate in the U.S. at 2.8%, largely due to a state health reform law passed in 2006 that predates the ACA.
What percentage of Hispanic Americans are uninsured?
24.6% of Hispanic adults ages 18-64 were uninsured in 2024, nearly three times the rate for white non-Hispanic adults at 7.9%.
How many children are uninsured in the US in 2026?
Roughly 3.7 million children were uninsured in 2024, a rate of 5.1%, up from 3.9% the year before, the first meaningful increase in child uninsurance in years.
What is the Medicaid coverage gap?
The coverage gap refers to low-income adults in non-expansion states who earn too much to qualify for traditional Medicaid but too little to qualify for ACA marketplace subsidies. An estimated 1.4 to 2 million Americans fall into this gap nationwide, with Texas alone accounting for roughly 588,000 of them.
How many people signed up for ACA marketplace coverage in 2026?
23.1 million people selected ACA marketplace plans during the 2026 Open Enrollment Period, down 4.9% from the record 24.3 million who enrolled in 2025.
Why are ACA marketplace deductibles rising in 2026?
Average marketplace deductibles rose 37% to a record $3,786 per person in 2026, largely because many enrollees shifted from Silver plans to cheaper, higher-deductible Bronze plans to offset the loss of enhanced premium subsidies.
Are more Americans uninsured now than during the pandemic?
Not yet, but the gap is closing. The uninsured rate was 9.7% in 2020 during the pandemic and fell as low as 8.9% by 2023. With 2026 projections running as high as 9.5%, the country is on pace to approach pandemic-era uninsured levels again.
Does having health insurance protect against medical debt?
Only partially. Insured Americans still make up a majority of total medical debt dollars nationwide, largely because high-deductible health plans, which now cover more than half of privately insured workers, leave people exposed to thousands of dollars in costs before coverage meaningfully kicks in.
Disclaimer: The data research report we present here is based on information found from various sources. We are not liable for any financial loss, errors, or damages of any kind that may result from the use of the information herein. We acknowledge that though we try to report accurately, we cannot verify the absolute facts of everything that has been represented.
