Numbers of uninsured Americans are rising.
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With rising numbers of uninsured for healthcare, hospitals are raising the alarm, according to multiple recent reports, including from the New York Times and Wall Street Journal. Under federal law, hospitals in the United States are required to treat patients with emergency medical conditions regardless of insurance status or ability to pay. Nevertheless, as more people go without insurance, hospital revenues decline, insurance premiums throughout the system increase and medical debt levels rise.
Hospitals are seeing a growing number of uninsured enter their doors. The percentage of medical bills that hospitals are unable to collect over time is up by more than a third compared to last year. This includes bills incurred by individuals who are underinsured, that is, they have insurance but face high out-of-pocket costs that they’re not able to pay.
The number of uninsured Americans sits at around 30 million currently. That’s well below the figure of 46.5 million in 2010, which was the year President Obama signed the landmark Affordable Care Act. Policies implemented by both the Trump and Biden Administrations during the Covid-19 pandemic further reduced numbers of uninsured people to 26 million, as the federal government facilitated the enrollment of millions into public health insurance programs.
Despite the percentage of uninsured hitting a record low of 7.7% in the first quarter of 2023, it’s been rising since. The increasing numbers of uninsured are in part due to Medicaid eligibility redeterminations that began under President Biden in 2023 and 2024 in the wake of a winding down of Covid-19 era policies that had greatly expanded Medicaid enrollment. This entails a process states deploy to confirm that individuals still qualify for Medicaid benefits. And now, under the Trump administration, cuts to the ACA, mainly following the decision by Congress not to extend enhanced Covid-19 era subsidies, are causing an increase in the uninsured rate.
And in 2025, 800,000 more folks lost coverage, pushing the uninsured rate up slightly. But it appears that the official figures for 2026, which won’t be released until early next year, will show a much more substantial increase due to several factors, starting with expiration of enhanced ACA subsidies that made premiums more affordable. This has led to an estimated 2.6 million people exiting the ACA exchanges. The drop came as people dropped plans that in some cases started costing them twice as much after enhanced federal subsidies lapsed at the start of this year. It’s unknown precisely how many of these people have alternative sources of coverage. Yet, based on reports it’s probable that many are forgoing health insurance altogether.
Moreover, independent assessments, such as those produced by the Congressional Budget Office, project that the uninsured rate will rise over the next several years owing to a tightening of restrictions regarding Medicaid eligibility, further declines in ACA exchange enrollment and a health insurance market where higher premiums are pricing some employers and employees out of affordable coverage. As Medicaid work requirements take effect in 2027, this could swell the ranks of the uninsured further. This implies that certain adults must engage in employment, education or community service activities to maintain their Medicaid coverage status. The CBO forecasts a further 4.1 million people will lose coverage in 2027 and it estimates approximately 10 to 14 million additional uninsured Americans over the coming decade.
Not having health insurance coverage doesn’t mean patients can’t go to emergency rooms and get treatment. Federal and state laws require that most hospitals serve the uninsured. But rising numbers of uninsured getting care in hospitals means insurance premiums go up, hospital revenues drop and patients’ medical debt increases.
And then there are the growing numbers of underinsured. According to a Commonwealth Fund report, even when the rate of uninsured hit an historic low of 7.7% in 2023, the underinsured tally was rising. In 2022, 43% of working-age adults were inadequately insured, with either no insurance, gaps in coverage or unaffordable access to certain medical services or technologies. What this implies is that many people who technically have health insurance still incur very high out-of-pocket costs, including for prescription drugs.
According to KFF, approximately 50% of Americans say it’s already “difficult to afford healthcare.” So, tens of millions of Americans are in a tenuous position regarding their ability to pay for healthcare at any given time during the year. The precariousness of a healthcare system in which patchy coverage is so widespread means that some folks have the proverbial sword of Damocles hanging over their head. Nearly one in five American households carry medical debt, which means that they were unable to pay a medical bill when they received care. Among households with medical debt, the median amount owed is approximately $2,000. About twice as many households without adequate insurance have medical debt than those with sufficient coverage. And according to a study published in the American Journal of Public Health, roughly 530,000 people reported falling into bankruptcy annually as a consequence of medical bills.
Universal healthcare access continues to be elusive in the U.S. Addressing the problem of lack of (adequate) health insurance for many Americans would involve a massive undertaking and one for which there isn’t bipartisan support at present.
Speaking at a STAT Summit in Boston in October 2023, Massachusetts Institute of Technology economist Amy Finkelstein suggested automatic enrollment of everyone in a “basic plan” as a necessary step in the direction toward universal access. Basic plans wouldn’t cover all services, just those deemed “essential.” And they would do so with minimal patient cost-sharing.
While this could be accomplished by way of a single payer such as the Medicare for All concept, a multiple payer system could also do the job as is the case in several European countries that provide (near) universal access to essential care, managed by private insurers. These include the Dutch and Swiss healthcare systems, for example. But whether the U.S. will ever move in this direction as a way to attempt to resolve the un- and underinsurance problem remains to be seen.