Uninsured Americans in 2025: 27 Million Without Coverage as ACA Subsidies Face Expiration

The uninsured rate held at 8% in 2024, leaving 27.1 million Americans without coverage, unchanged from 2023 but up from 2022's record low of 7.9%. State-level data show warning signs of a coverage crisis: 18 states and Washington, D.C., experienced increases in their uninsured populations in 2024, signaling vulnerability in coverage gains.

Census Bureau data released in September 2025 show cracks in coverage gains achieved over the past decade. Another 3.8 million people are projected to lose coverage annually starting in 2026 if enhanced ACA subsidies expire as scheduled on December 31, 2025.

Open enrollment runs from November 1, 2025 through January 15, 2026. The end of Medicaid protections and expiring subsidies could trigger a coverage crisis. Without congressional action, the uninsured population could climb to 31 million or higher by 2027.

The 2024 uninsured rate of 8% represents 27.1 million Americans, up by 670,000 from 2023's 26.4 million. Eighteen states and Washington, D.C., saw increased uninsured populations, ending pandemic-era coverage gains.

Coverage Peaked in 2010, Then Declined

In 2010, 48.2 million Americans under age 65 lacked coverage, 18.2% of the population. The ACA reduced uninsured rates steadily after 2014 when marketplace subsidies launched and many states expanded Medicaid eligibility. The uninsured rate reached a record low of 7.9% in 2022 before rising to 8% in 2023 and holding at 8% in 2024.

Policy changes, not economic conditions, drove the 2024 increase. Coverage losses in 18 states plus D.C. show these gains remain fragile.

Medicaid Unwinding Creates Coverage Losses

Medicaid disenrolled 25.2 million people between March 2023 and September 2024. Sixty-nine percent lost coverage due to paperwork problems and overwhelmed state systems, not because they were ineligible. Families missed renewal notices, couldn't navigate complex forms or missed tight deadlines.

While many transitioned to employer or marketplace plans, the uninsured population increased by 670,000 in 2024, largely driven by Medicaid unwinding.

Enhanced ACA premium subsidies expire on December 31, 2025. Without congressional action, 22 million Americans who rely on enhanced premium tax credits face premium increases averaging 114% starting in 2026. The Congressional Budget Office projects 3.8 million people will lose coverage annually.

Premiums Jump 114% Starting January 1, 2026

Twenty-two million Americans currently receive enhanced premium tax credits through ACA marketplaces. If Congress doesn't act, premiums will jump an average of 114% ($1,016 annually) for affected households, a sharp increase over the average cost of health insurance.

Households that remain insured despite higher costs may face underinsurance. To keep premiums affordable, these families may choose plans with higher deductibles and narrower networks.

Four Groups at Highest Risk

Middle-income families earning too much for Medicaid but dependent on subsidies face the highest risk. Self-employed and gig workers without employer coverage lack alternatives. Health insurance for early retirees aged 50 to 64 can be increasingly unaffordable due to age-based pricing. Young adults ages 19 to 25 (14.1% uninsured) may drop coverage they view as unaffordable, pushing the rate higher.

Non-Expansion States Face Additional Challenges

States that haven't expanded Medicaid face additional coverage challenges. Texas leads the nation with a 16.7% uninsured rate (21.6% among working-age adults), accounting for 588,000 of the 1.4 million Americans in the coverage gap: people who earn too much for Medicaid but too little for subsidies. Oklahoma (11.5%), Florida (10.9%) and Georgia (12%), all non-expansion states, will see similar pressures as subsidy-dependent residents lose affordable options in 2026.

Eighteen states and Washington, D.C., saw increased uninsured populations in 2024. Coverage losses were concentrated in the Midwest and states experiencing severe Medicaid unwinding challenges. California and North Carolina bucked the trend with decreases.

State uninsured rates vary dramatically, from Massachusetts' 2.8% to Texas' 16.7%. The highest uninsured states have a common pattern: most haven't expanded Medicaid. Texas leads the nation at 16.7%, followed by Oklahoma (11.5%), Nevada (11.4%), Alaska (11%) and Florida (10.9%).

Working-age adults face higher rates than these all-ages figures. Texas' working-age adults have a 21.6% uninsured rate, and Georgia's reaches 16.5%. Non-expansion states like Texas, Georgia, Oklahoma and Florida account for millions of Americans in the coverage gap: people who earn too much for Medicaid but too little for marketplace subsidies.

States with the lowest uninsured rates concentrate in the Northeast and the West. Massachusetts, Hawaii, Vermont, New Hampshire and Washington, D.C., maintain rates below 4.5%, showing how Medicaid expansion and strong state exchanges reduce coverage gaps.

Note: Rankings use all-ages data for consistent state-to-state comparisons. Working-age adults (ages 19 to 64) face higher uninsured rates than the all-ages average because seniors have near-universal Medicare coverage. Texas' working-age rate is 21.6% compared to its 16.7% all-ages rate.

Medicaid expansion status shows a strong correlation with uninsured rates. States that expanded Medicaid under the ACA maintain lower uninsured rates than non-expansion states.

Ten states haven't expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. Most of these states have high uninsured rates. Four of these states (Texas, Georgia, Oklahoma and Wyoming) have uninsured rates above 10%. South Carolina (9%), Kansas (8%) and Wisconsin (5%) are exceptions.

The pattern has a political dimension. MoneyGeek's analysis shows that all 10 non-expansion states voted Republican in 2024, linking health insurance access to political decisions.

Around 1.4 million Americans in non-expansion states earn too much to qualify for traditional Medicaid but not enough to receive marketplace subsidies, which begin at 100% of the federal poverty level.

The uninsured population isn't distributed evenly across America. Young adults, Hispanic Americans and men have much higher uninsured rates, each for distinct reasons. These demographic patterns matter because they reveal where the 2026 subsidy cliff will hit hardest. Understanding who lacks coverage and why helps identify which Americans face the greatest risk when enhanced subsidies expire.

By Age

Young adults aged 19 to 25 face the highest uninsured rate at 14.1%. This reflects coverage eligibility transitions. CHIP coverage ends at age 19, and many young adults lose access to their parents' health insurance at age 26.

Children under 18 have a 5.1% uninsured rate, benefiting from CHIP and expanded Medicaid eligibility for minors. Working-age adults ages 18 to 64 have an 11.6% uninsured rate. Seniors 65 and older have a 0.6% uninsured rate due to near-universal Medicare coverage.

High uninsured rates among young adults threaten marketplace stability. Younger, healthier enrollees help balance insurance risk pools. When young adults drop coverage due to cost, insurers face higher average claims costs, potentially driving further premium increases.

Note: This section uses ages 18 to 64 based on CDC/NHIS data definitions. State-by-state comparisons use ages 19 to 64 based on Census ACS data, which provides the most detailed state-level working-age breakdowns.

By Race and Ethnicity

Hispanic Americans have the highest uninsured rate at 24.6% among adults ages 18 to 64, nearly four times the rate of white non-Hispanic Americans (7.9%). This disparity exists even though Hispanic Americans comprise roughly 19% of the U.S. population.

Uninsured rates by race and ethnicity (adults ages 18 to 64):

• Hispanic: 24.6%
• American Indian/Alaska Native: 19.1%
• Black non-Hispanic: 10.5%
• White non-Hispanic: 7.9%
• Asian non-Hispanic: 5.4%

These disparities remain despite ACA coverage gains. Income levels, immigration status, language barriers and industry employment patterns contribute to higher uninsured rates among Hispanic workers, who are more likely to work in industries that don't offer health benefits, such as construction, agriculture and food service.

By Gender

Men consistently face higher uninsured rates than women. In 2024, 13% of men ages 18 to 64 lacked health insurance compared to 10.1% of women.

Women are more likely to qualify for Medicaid under categories including pregnancy and being the parent of children under 18. Women also tend to have lower average incomes than men, making them more likely to meet Medicaid income thresholds. Men, particularly those without dependent children, face more limited Medicaid eligibility in many states.

Cost remains the dominant barrier and continues to grow. According to Kaiser Family Foundation data, 63.2% of uninsured adults cite affordability as the primary reason they lack coverage, underscoring the need for the most affordable health insurance options. Affordability will worsen for millions currently relying on enhanced subsidies when premiums increase in 2026.

Non-expansion states create a coverage gap for 1.4 million Americans who earn too much for Medicaid in their states but too little to receive marketplace subsidies.

Open enrollment for 2026 marketplace plans runs from November 1, 2025 through January 15, 2026. It may be the last chance to find affordable coverage and the best health insurance at current subsidy levels. IEnhanced subsidies may decrease or end completely if Congress doesn't act.

Action Steps

With 22 million Americans facing premium increases of 114% in 2026 and coverage losses accelerating in 18 states, accurate data matters for understanding who's at risk. MoneyGeek combined multiple government and nonprofit data sources to track the 2024 reversal, quantify the impact of Medicaid unwinding and project the 2026 subsidy cliff effects.

Why Multiple Sources Matter

Coverage tracking requires different data for different questions. The Census Bureau surveys households annually, providing the most reliable state-by-state totals and year-over-year comparisons.

MoneyGeek used the Census Bureau's "Income, Poverty and Health Insurance Coverage in the United States: 2024" for the 27.1 million uninsured figure and all 50 state rankings. The American Community Survey (ACS 2024) supplied state-level demographic breakdowns.

We used the Census Bureau's 2023 report for young adult rates (ages 19 to 25: 14.1%). State-level rankings come from the American Community Survey (ACS 2024) using all-ages data for consistent comparisons. Working-age adults (ages 19 to 64) face higher uninsured rates than all-ages averages.

For historical context, MoneyGeek used CDC data that established the 2010 baseline of 48.2 million uninsured Americans under age 65 at the pre-ACA peak.

The CDC's National Health Interview Survey captures continuous data throughout the year, making it more reliable for tracking demographic patterns. MoneyGeek used NHIS 2024 for race and gender breakdowns (Hispanic: 24.6%, men: 13%, women: 10.1%).

Tracking Policy Impacts

For Medicaid unwinding data, MoneyGeek relied on the Kaiser Family Foundation's Medicaid Enrollment & Unwinding Tracker. KFF tracks disenrollments across all states and provides the figure for 25.2 million disenrolled.

For 2026 subsidy projections, MoneyGeek combined KFF's premium impact analysis with Congressional Budget Office estimates from "Federal Subsidies for Health Insurance Coverage for People Under 65: 2024 to 2034."

CBO projects 3.8 million additional people will become uninsured annually starting in 2026 based on its modeling of ACA subsidy expiration effects. KFF's analysis provided the 114% premium increase and $1,016 average annual cost jump figures. MoneyGeek verified these figures against CNBC's independent reporting of the same data.

For coverage gap data, MoneyGeek used KFF's analysis showing that 1.4 million Americans in non-expansion states earn too much for Medicaid but too little for marketplace subsidies. KFF's "Key Facts About the Uninsured Population" provided the 63.2% cost barrier statistic.

MoneyGeek's Approach

MoneyGeek cross-referenced all data points across sources to verify consistency. Where sources differed slightly due to methodology (Census annual surveys vs. NHIS continuous tracking), MoneyGeek noted these differences and used each source for its strength: Census for state totals and trends, NHIS for demographic detail, KFF for policy analysis, CBO for future projections.