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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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  • Outreach and Enrollment Strategies for Reaching the Medicaid Eligible but Uninsured Population

    Issue Brief

    This brief identifies a range of successful strategies to reach and enroll Medicaid- and CHIP-eligible individuals as well as options to facilitate renewals. It draws on a collection of previous work examining state enrollment experiences after implementation of the ACA. In sum, it shows that states that have achieved enrollment success have embraced an array of strategies and approaches that include promoting the expansion through strong leadership and collaboration, implementing broad marketing and outreach campaigns, establishing a coordinated and diverse network of assisters, developing effective eligibility and enrollment systems that coordinate with the Marketplace, and planning ahead to translate coverage gains into improved access to care.

  • Obamacare Debate: Where GOP Governors Stand on Repeal and Replace

    From Drew Altman

    As congress prepares to vote on repeal of the Affordable Care Act, Drew Altman discusses whether Republican governors and congressional Republicans will be at odds over key issues when it comes to repealing and replacing the law in this Wall Street Journal Think Tank column.

  • Analysis: Nearly 12 Million People Who Remain Uninsured Are Eligible for Financial Help Under the Affordable Care Act, About Half Through Medicaid and Half Through the Marketplaces

    News Release

    As the Nov. 1 start of the Affordable Care Act’s fourth open enrollment period approaches, a new Kaiser Family Foundation analysis estimates that 11.7 million people who remain without health insurance are eligible for Medicaid in their state or for tax credits to purchase health insurance through their state’s Affordable Care Act marketplace.

  • Insurance Coverage Changes for People with HIV Under the ACA

    Issue Brief

    This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV.

  • The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey

    Report

    To date, there has been little research providing a quantitative look at the causes of medical bill problems and the impacts they have on people’s families, their finances, and their access to health care. To fill this gap, the Kaiser Family Foundation and The New York Times conducted an in-depth survey with 1,204 adults ages 18-64 who report that they or someone in their household had problems paying or an inability to pay medical bills in the previous 12 months.

  • Michigan’s Medicaid Section 1115 Waiver to Address Effects of Lead Exposure in Flint

    Fact Sheet

    On February 13, 2016, Governor Rick Snyder submitted a Medicaid Section 1115 Waiver proposal to the Centers for Medicare and Medicaid Services (CMS) to address issues related to lead exposure in Flint, Michigan. This fact sheet provides some insight into the situation in Flint, Michigan, the history of Medicaid disaster relief waivers and the details of the Medicaid waiver request.

  • Health Coverage Among Community Health Center Patients, 2019-2024

    Community Health Center Patients, Financing, and Services

    Issue Brief

    Community health centers served more than 32 million patients in medically underserved urban and rural areas in 2024. This brief reports on health center patients, services, and financing in 2024, using national data from the Uniform Data System (UDS).