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2025 KFF Marketplace Enrollees Survey

If the amount they pay in premiums doubled, about one in four enrollees in ACA Marketplace health plans say they would “very likely” go without insurance in 2026, finds a KFF survey of Marketplace enrollees fielded shortly after open enrollment began in the first weeks of November 2025. One in three say they would be “very likely” to look for a lower-premium Marketplace plan.

Health Coverage Among Community Health Center Patients, 2019-2024

Community Health Center Patients, Financing, and Services

Changes to Medicaid and the ACA Marketplace included in the 2025 reconciliation law and the expiration of ACA Marketplace enhanced premium tax credits at the end of 2025 are likely to increase the number of uninsured patients and patients who cannot afford out-of-pocket costs, placing new financial burdens on community health centers.

Data and analysis

The Uninsured Population and Health Coverage

This Health Policy 101 chapter examines the share of the United States population who are uninsured, highlighting their demographics and the challenges they face because of the lack of coverage.

How Many Uninsured Are in the Coverage Gap?

This analysis estimates that 1.4 million uninsured individuals in the 10 states without Medicaid expansion, including many working adults, people of color, and those with disabilities, remain in the “coverage gap,” ineligible for Medicaid or for tax credits that would make coverage ACA's Marketplaces affordable to them.

Key Facts about the Uninsured Population

The number of people ages 0-64 who were uninsured held steady at 25.3 million in 2023, although the number of uninsured children rose from 3.8 million to 4.0 million. Most uninsured people are in low-income families and have at least one worker in the family.

How the Unwinding Affected Enrollees

Over half who were disenrolled say they put off needed medical care while trying to renew Medicaid. Overall, 19% of adults who had Medicaid prior to the start of unwinding say they were disenrolled at some point in the past year. Of this group, a large majority (70%) were left at least temporarily uninsured.

The uninsured: How costs affect care and health, 2023

Latest Polling
8%

Percent of adults who reported not having health insurance
55%

Percent of uninsured adults who reported delaying or forgoing some form of health care due to cost
19%

Percent of uninsured adults who report that they or a family member had difficulty paying medical bills
38%

Percent of uninsured adults who reported not having a usual source of care (vs. 8% of insured adults)
Peterson-KFF Health System Tracker

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  • Kaiser Health Tracking Poll: January 2014

    Feature

    With enrollment in new coverage options underway, a majority of the public believes that only “some” of the ACA’s provisions have been put into place, while just about one in five think “most” or “all” of the law has been implemented. Awareness of the law’s individual mandate and health insurance exchanges has increased slightly since last year, but about four in ten of the public overall and half the uninsured remain unaware of other major provisions. For the third month in a row, overall views of the law remain at their post-rollout more negative levels (50 percent unfavorable, 34 percent favorable), though over half the public – including three in ten of those who view the law unfavorably – say opponents should work on improving the law rather than keeping up efforts to repeal it.

  • How Will the Uninsured in Vermont Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Vermont, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Vermont are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, the report quantifies how many uninsured people fall into the “coverage gap,” meaning they will be ineligible for financial assistance in the Marketplace or for Medicaid in their state despite having an income below the federal poverty level.

  • The Health-Care Enrollment Story Is in the States

    News Release

    In his latest column for The Wall Street Journal's Think Tank, Drew Altman examines the variation among states beneath the national Affordable Care Act’s Marketplace enrollment numbers released by the U.S. Department of Health and Human Services. All previous columns by Drew Altman are available online.

  • Majority of Public Says Congress Should Act to Close Gaps if the Supreme Court Bars Financial Help for Purchasing Insurance in States Relying on healthcare.gov; Most in Potentially Affected States Want Their State To Set Up Its Own Marketplace if Needed

    News Release

    Views Mixed on Changes to Definition of Full-Time Work For Employer Mandate, with More Opposed than Supportive, And a Third Saying They Don't Know Enough to Say Public Remains Divided Over Next Steps for the Affordable Care Act, Though Most Expect Major or Minor Changes under GOP Congress this Year Though few Americans are paying…

  • Kaiser Health Tracking Poll: January 2015

    Feature

    The latest Kaiser Health Tracking Poll finds though few Americans are paying attention to the pending Supreme Court case over whether the health care law says that people in all states can get financial help to buy health insurance, most say they would want Congress and their state to act to fix potential gaps should the Supreme Court rule in favor of the plaintiffs. With a new Republican majority controlling both Houses of Congress, the public remains divided on what they would like Congress to do next with the Affordable Care Act (ACA) overall. About a third (32%) say they favor repeal, another 14 percent would like the law scaled back, 19 percent want the law to move forward as is, and nearly a quarter (23%) would like to see the law expanded.

  • National Survey Finds 10.6 Million People Helped By Navigators and Assisters During the Affordable Care Act’s First Open Enrollment Period

    News Release

    An estimated 10.6 million people nationally received personal help from navigators and assisters during the Affordable Care Act's first open enrollment period, finds a new Kaiser Family Foundation survey of navigators and assister programs nationally. The survey estimates that the 4,400 assister programs operating nationally had an estimated 28,000 full-time staff and volunteers, suggesting each assister would have helped more than 370 people on average during the six-month open enrollment period that ran from October 1 through March 31.

  • The Affordable Care Act and Insurance Coverage in Rural Areas

    Issue Brief

    Rural populations face disparities compared to metropolitan populations in health care. While rural individuals were not more likely to be uninsured than metropolitan counterparts pre-Affordable Care Act, they were poorer and less likely to have private insurance. With coverage changes in the ACA involving an expansion of Medicaid for poor and near-poor populations, decisions by states with large rural populations may cause rural residents to have disparate access to coverage, which may exacerbate cost and access barriers to health care.

  • Health and Health Coverage in the South: A Data Update

    Issue Brief

    This brief provides key data on the South and the current status of health and health coverage in the South to provide greater insight into the health needs in the region and the potential coverage gains that may be achieved through the ACA. It includes data on the uninsured, Medicaid expansion and eligibility for coverage.