Healthcare coverage gaps and rising costs are key issues for voters in this year’s midterms. Driven by several federal policy changes and surging health insurance premiums in the commercial market and on the Affordable Care Act exchanges, it’s expected that 2027 will see the largest spike in recent memory of the numbers of un- and underinsured individuals in the United States.

Roughly 30 million Americans are uninsured today. This number is predicted to increase substantially in 2027 and beyond . The Congressional Budget Office projects that the number of uninsured Americans will increase by 7.5 million in 2027 compared to 2025, with 4.1 million more people expected to lose insurance in 2027 alone. By the end of next year, the nation could have an uninsured rate of as high as 10%. And by 2034, at least another 7 million will go without coverage.

In addition, approximately a quarter of working-age Americans with health insurance are underinsured, which means they have high out-of-pocket costs relative to their income. These expenses often amount to thousands of dollars in deductibles as well as co-payments for healthcare services and technologies. As the ranks of the underinsured swell, this will likely result in delayed care and rising medical debt .

The escalating annual rate of increase in out-of-pocket healthcare costs is well in excess of the already high pace of inflation measured by the consumer price index. This double whammy exacerbates the problem of affordability for the typical American whose wages recently haven’t grown commensurately. According to KFF, healthcare costs are at the top of the list of people’s financial worries in 2026.

Here, the big story isn’t just healthcare affordability , it’s also the precarity of health insurance for many Americans and the loss of coverage for millions. Just three years ago, the U.S. rate of uninsured was at a historic low of 7.2%. The numbers of uninsured have climbed slowly since 2023, but are expected to accelerate in 2027.

Not having insurance can seem like a gamble worth taking for someone who’s relatively young and healthy. But the uncertainty of one’s health status from one day to the next implies that this is a major risk. And for those who have underlying health conditions, being un- or underinsured can be financially toxic .

The main reasons for a re-emergence of a problem of lack of health coverage are a combination of federal policy changes to Medicaid and the ACA and spiking premiums in the commercial market driven by ever-growing healthcare costs.

Beginning in January 2027, federal rules mandate Medicaid work requirements and eligibility re-determinations by states on a biannual basis. Experts suggest this will lead to the disenrollment of millions.

Insurers have proposed a median 15% rate increase for 2027 Affordable Care Act marketplace plans, marking the second consecutive year of double-digit hikes. The expiration of enhanced ACA tax subsidies, combined with tighter enrollment rules is causing millions to drop out of or fail to renew their ACA insurance on the exchanges.

In the commercial sector, employer-sponsored health benefits are forecast to rise in costs by 8.2% to 11% in 2027. This has a twofold effect. Employers are likely to impose a greater financial burden on workers via higher deductibles, co-payments and out-of-pocket maximums. And in all probability, higher costs of insurance will in turn crowd out wage growth. For those consumers who maintain coverage in 2027, they will typically face increasing deductibles and greater co-payments.