Nearly one in three workers with employer health insurance cannot affordably access the care their plan is supposed to cover. The figure comes from the Commonwealth Fund’s 2026 Biennial Health Insurance Survey. It sits beneath a more prominent headline about the uninsured, but describes what is happening inside the plans benefits advisors are renewing right now.
The survey, conducted by research firm SSRS between May and July 2026, covered a nationally representative sample of 9,360 adults aged 19 and older. Its findings reflect conditions after the expiration of enhanced ACA premium subsidies at the end of 2025, but before the Medicaid changes under H.R. 1 take effect in 2027.
The uninsured rate among working-age adults aged 19 to 64 rose from 8.9% in 2024 to 11.2% in 2026, a statistically significant increase. Overall, 46% of working-age adults were inadequately insured. That breaks down as 11% uninsured, 12% with a coverage gap, and 23% underinsured. The underinsured group had plans that did not provide affordable access to care.
Among adults insured all year, 30% were underinsured overall. Among those with employer-sponsored insurance specifically, the figure was 29%. Two in three underinsured adults had employer coverage. That figure has held across prior editions of the survey, pointing to a structural problem rather than a recent shift.
More than half of marketplace enrollees did not get needed care because of cost, and one-third were carrying medical debt. Among people with employer coverage, the comparable figures were 43% and 31% respectively. The gap between employer and marketplace enrollees is narrower than many employer clients tend to assume.
The survey also found that 50% of all working-age adults avoided needed care because of cost, up from 46% in 2022. That increase held among people who were insured all year, which means the deterioration in access is not solely explained by people losing coverage.
The rise in the uninsured rate traces directly to two policy changes. ACA marketplace and individual market coverage fell from 8.5% of working-age adults in 2024 to 6.4% in 2026. Medicaid coverage declined from 15.5% in 2022 to 13% in 2026. Both shifts followed the end of pandemic-era policies: enhanced premium tax credits that expired at the end of 2025, and continuous Medicaid enrollment provisions.
According to the survey's authors, the expiration of the enhanced credits raised average annual premiums by amounts ranging from $750 to $4,035 depending on income. Among marketplace enrollees who remained covered, 19% said they moved to lower-premium plans with higher deductibles and out-of-pocket costs after the subsidies lapsed.
Total US health insurance enrollment fell 2.8% in the 12 months through June 30, 2026, according to data from Mark Farrah Associates. Losses were concentrated in Medicaid, the individual market, and fully insured employer plans. Self-funded employer arrangements grew over the same period, as some workers who had previously taken marketplace coverage instead of their employer's plan shifted back into employer coverage when the subsidies lapsed. That shift is adding members to employer books, and the survey’s underinsurance data suggests those books already carry significant coverage-quality pressure.
The survey’s authors are explicit that the findings represent conditions before major Medicaid provisions take effect. H.R. 1 includes work requirements of 80 hours per month for most Medicaid expansion enrollees and eligibility redeterminations every six months. The Congressional Budget Office projects the law's Medicaid and marketplace changes will result in 10.9 million more uninsured Americans by 2034.
The enrollment pressure is expected to fall hardest on small and mid-market employers with large hourly or lower-wage workforces, where workers had previously relied on subsidized individual coverage rather than their employer’s plan.
The Commonwealth Fund outlined several policy options, including permanently extending the enhanced premium tax credits and eliminating Medicaid work requirements. It also proposed eliminating deductibles in commercial plans paired with caps on provider payment rates. Whether Congress acts on any of those options is uncertain.
