Half of working-age adults went without needed care because of cost, survey finds
The Commonwealth Fund's biennial insurance survey found cost-related barriers to care rising since 2022, including among adults who had coverage all year.
Half of U.S. adults ages 19 to 64 said they went without needed care because of the cost, up from 46% in 2022, according to the Commonwealth Fund's 2026 Biennial Health Insurance Survey, released October 22. That meant not filling a prescription, skipping a recommended test or treatment, not seeing a doctor when sick, or not getting needed specialist care, the foundation said in its announcement of the findings1.
The survey also tracks whether coverage protects people from high costs. The foundation counts someone as underinsured if they were covered all year but their out-of-pocket costs, not counting premiums, equaled 10% or more of household income (5% or more for people with low incomes), or their deductible equaled 5% or more of income. By that measure, 23% of working-age adults were underinsured in 2026, according to the survey's published charts2.
Among adults insured all year, 30% were underinsured. The rate was 29% for people with employer coverage and 51% for people with marketplace or other individual-market plans, where 39% had a deductible equal to 5% or more of their income. It was 20% for adults in Medicaid and 38% for Medicare enrollees under 65, the survey found.
Cost problems reached people with steady coverage, too. Among adults insured all year, 43% reported at least one cost-related problem getting care, up from 40% in 2022. That share was 52% for people in marketplace or individual plans and 43% for people with employer coverage. Underinsured adults fared worse than other insured adults: 59% reported a cost-related problem and 47% had medical or dental bills or other health care debt, compared with 36% and 23% for insured adults who were not underinsured, according to the charts. More than 70% of uninsured adults reported cost-related problems.
Medical debt was widespread. Nearly a third of working-age adults are paying off medical bills or debt, including 31% of those insured all year through an employer and 33% of those with marketplace or individual plans, according to the release.
Fewer people had insurance at all. The share of working-age adults without coverage rose from 8.9% in 2024 to 11.2% in 2026, a statistically significant increase that the foundation linked to the expiration of enhanced Affordable Care Act (ACA) marketplace premium tax credits at the end of 2025 and the end of pandemic-era protections that kept people enrolled in Medicaid. Marketplace and individual-market coverage fell from 8.5% of working-age adults in 2024 to 6.4% in 2026, and Medicaid coverage fell from 15.5% in 2022 to 13%. Among adults ages 19 to 34, the uninsured rate rose from 11% to 16%.
SSRS conducted the survey by phone and online, in English and Spanish, from May 7 to July 20, 2026, among a nationally representative sample of 9,360 adults. Most results cover the 7,362 respondents ages 19 to 64, with a margin of sampling error of plus or minus 1.5 percentage points. The findings rest on what respondents reported about their coverage, costs and income, not on claims or billing records.
The report's authors expect further coverage losses as Medicaid cuts and new restrictions on ACA marketplace coverage take effect in 2027, citing Congressional Budget Office estimates that federal policy changes will leave 37 million people uninsured by 2036. Sara Collins, the lead author, said in the release that the country is "on the brink of undoing years of progress in health coverage." The policy options in the report include restoring the enhanced marketplace tax credits, eliminating deductibles in commercial plans and limiting provider payment rates to offset premium increases.
