The Uninsured in 2026: 8% of Americans Still Without Coverage
Census HTOPS data shows 7.45% of Americans lack health insurance. By region, income, and age — who falls through the cracks.
Despite decades of health care reform, 7.45% of Americans — roughly 19.4 million adults — lack health insurance according to the 2026 Census HTOPS survey. The uninsured rate has improved from pre-ACA levels above 15%, but stubborn gaps remain, concentrated by geography, income, and age.
The National Insurance Picture
The HTOPS data shows how Americans are covered:
- Employer-sponsored insurance: 57.04% — still the backbone of American coverage
- Medicare: 28.28% — reflecting the large retiree population
- Medicaid/CHIP: 20.36% — the safety net for low-income Americans
- Directly purchased (marketplace): 15.64% — ACA marketplace plans
- TRICARE/VA: 8.10% — military and veteran coverage
- Uninsured: 7.45%
Note that percentages sum to more than 100% because respondents can have multiple coverage types.
The Geography of Uninsurance
The regional data reveals a clear policy divide:
Highest uninsured rates:
- West South Central (AR, LA, OK, TX): 16.10% — more than double the national average. Texas alone accounts for a significant share, having declined to expand Medicaid under the ACA. Arkansas expanded Medicaid through a private option but Oklahoma and Louisiana have mixed records.
- Mountain (AZ, CO, ID, MT, NV, NM, UT, WY): 10.59% — several states in this division were late Medicaid expanders or have large undocumented populations ineligible for coverage
- East South Central (AL, KY, MS, TN): 8.96% — Alabama and Mississippi have not expanded Medicaid
Lowest uninsured rates:
- New England (CT, ME, MA, NH, RI, VT): 2.67% — Massachusetts pioneered universal coverage before the ACA, and all New England states expanded Medicaid
- East North Central (IL, IN, MI, OH, WI): 3.72% — Medicaid expansion and strong employer coverage
- Middle Atlantic (NJ, NY, PA): 4.80% — despite other challenges, the Northeast covers its residents relatively well
The 6× gap between New England (2.67%) and the West South Central (16.10%) illustrates how state policy choices on Medicaid expansion directly shape coverage rates.
Income and Uninsurance
Income is the strongest predictor of coverage status. Americans earning under $25K are far more likely to be uninsured than those above $75K. The coverage gap is sharpest in states without Medicaid expansion, where adults earning between 100–138% of the federal poverty level fall into a "coverage gap" — too much income for Medicaid, too little for affordable marketplace plans.
The $25K–$50K range is particularly vulnerable. These workers often hold jobs that don't offer employer coverage (retail, food service, gig work) but earn too much for Medicaid in non-expansion states.
Age and Coverage
Coverage patterns follow a predictable age curve:
- 18–24: Higher uninsured rates, as young adults age off parental plans at 26 and may not have employer coverage
- 25–39: The peak uninsured age range — old enough to have aged off parental plans, working in industries less likely to offer coverage
- 40–64: Gradually declining uninsured rates as careers stabilize and employer coverage becomes more common
- 65+: Near-universal coverage through Medicare (though supplemental coverage varies widely)
The ACA's provision allowing adults to stay on parental plans until 26 helped, but the 25–39 cohort remains the most vulnerable.
The Cost of Being Uninsured
The 19.4 million uninsured Americans face real consequences: delayed preventive care, emergency room visits for treatable conditions, medical debt as the leading cause of personal bankruptcy, and worse health outcomes. Studies consistently show that gaining insurance coverage improves health, increases access to care, and reduces financial strain.
What Would Move the Needle?
The data points to clear policy levers. The states with the highest uninsured rates are overwhelmingly those that declined Medicaid expansion. If every state expanded Medicaid, an estimated 2–4 million additional adults would gain coverage. Improving marketplace subsidies and addressing the "family glitch" in employer coverage could reach millions more.
The 2026 HTOPS data serves as a reminder: America's uninsured problem is smaller than it was a decade ago, but it hasn't gone away — and it's concentrated in places where policy choices leave the most vulnerable without coverage.
*Explore health insurance data on our Health page. See state-level estimates on our States pages.*
Data source: U.S. Census Bureau HTOPS, March 2026.