30% of Employer-Sponsored Adults Are Underinsured

The percentage of U.S. adults with employer-sponsored health insurance who are underinsured has reached one in three, according to a new Commonwealth Fund survey. The analysis found that 30% of adults insured throughout the year were underinsured, meaning their deductibles or out-of-pocket costs were high relative to income. This includes 29% with employer coverage and half with marketplace plans. Overall, 46% of working-age adults had inadequate coverage in 2026, up from 46% in 2022. The uninsured rate among adults ages 19 to 64 rose from 8.9% in 2024 to 11.2% in 2026, with the increase most pronounced among young adults.

Among adults ages 19 to 34, the uninsured rate increased from 11% to 16%. For working-age adults with incomes below twice the federal poverty level, it rose from 14% to 17%. Sara R. Collins, lead author and Commonwealth Fund senior scholar, stated, “The country is on the brink of undoing years of progress in health coverage.” The survey, conducted May 7 through July 20, included 7,362 adults ages 19 to 64 with a margin of sampling error of plus or minus 1.5 percentage points.

The authors noted that their survey historically produces lower uninsured estimates than federal surveys due to methodological differences.

Impact on Access to Care

Cost barriers affected 43% of adults with employer coverage and more than half with marketplace plans who skipped needed care. About 30% of working-age adults were paying off medical debt. Dr. Joseph R. Betancourt, Commonwealth Fund President and primary care physician, observed that as a primary care physician, he has seen “health care get less and less affordable and know firsthand what happens – people skip doctor’s visits and medications because they can’t afford them and treatable illnesses become medical emergencies.”

The 2024 Commonwealth Fund survey found 57% of underinsured adults avoided care due to cost, and 44% were paying off medical or dental debt. Two in five working-age adults who delayed care reported health problems worsening. A March KFF follow-up survey revealed one in 10 people enrolled in marketplace coverage in 2025 were uninsured in 2026, with 80% of returning enrollees citing higher premiums or out-of-pocket costs.

Policy Recommendations and Future Implications

The authors recommend restoring enhanced marketplace premium tax credits, reversing Medicaid work requirements and more frequent eligibility reviews, and eliminating commercial-plan deductibles while limiting provider payment rates to offset premium increases. Employer healthcare costs are projected to rise 9.5% in 2027, according to Aon.