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The number of uninsured Americans rose in 2024 for the first time since 2019, reversing years of coverage gains driven by pandemic-era protections, according to a KFF issue brief dated April 9, 2026. Analyzing American Community Survey data, KFF found that the total number of people ages 0 to 64 without health coverage increased by more than 1.3 million, reaching 26.7 million, as the uninsured rate climbed from 9.5% to 9.8%.
The primary driver was a decline in Medicaid enrollment following the end of continuous enrollment provisions that had kept millions covered throughout the COVID-19 public health emergency. When states resumed eligibility determinations beginning in 2023, a process widely described as "Medicaid unwinding," coverage losses accelerated through 2024 as most states completed their redetermination cycles. While ACA Marketplace enrollment increased during the same period, supported by enhanced premium tax credits first enacted under the American Rescue Plan Act, those gains did not fully offset Medicaid losses.
The profile of the uninsured population carries significant implications for managed care plans and payers. More than 80% of uninsured individuals under 65 live in low-income families, and more than 63% are people of color. Adults in states that have not adopted Medicaid expansion faced an uninsured rate of 14.5%, nearly double the 8.0% rate in expansion states. Approximately 52% of the uninsured may qualify for Medicaid or subsidized Marketplace coverage but remain unenrolled, citing cost, complexity, or lack of awareness.
Looking ahead, the Congressional Budget Office projects that more than 14 million additional people could be uninsured by 2034, driven by the expiration of enhanced Marketplace subsidies and eligibility changes included in recent federal legislation.
