Hundreds gather outside the US Capitol in Washington, DC, against the of Medicaid and Medicare on March 12, 2025. (Photo credit: Aashish Kiphayet Shutterstock)
A comprehensive report on the state of the for-profit US healthcare system published Thursday shows that President Donald Trump and the Republican Party’s assault on Medicaid and the Affordable Care Act is on track to reverse more than a decade of progress on expanding insurance coverage, fueling a worsening medical debt crisis and forcing millions to delay or forgo treatment.
The Commonwealth Fund’s annual status report on the American health insurance system notes that the uninsured rate for working-age US adults rose from 8.9% in 2024 to 11.2% this year, as the Trump-GOP cuts to Medicaid and their refusal to extend enhanced ACA subsidies pushed millions off their coverage. The report emphasizes that the worst is yet to come, given that many of the Medicaid cuts included in the 2025 Trump-GOP budget law—including punitive new work reporting requirements—have not taken effect nationwide.
“The combined effects of these changes are expected to drive the number of uninsured people to 37 million by 2036—about the same as in 2014, when most of the ACA’s changes took effect,” the report observes. “At the same time, rapid growth in health costs is making both insurance and care even less affordable—and contributing to medical debt—for Americans across the country.”
Looking beyond just the uninsured rate, the Commonwealth Fund report shows that nearly half of working-age adults were “inadequately insured” this year due to a coverage gap or unaffordable plans. Around 30% of US adults reported having medical debt, according to the new report.
“Unlike peer countries, the US does not guarantee adequate health insurance for all its residents,” the report states. “Our survey findings show just how detrimental a lack of continuous coverage and high out-of-pocket costs are to people’s ability to afford care and maintain their health—without going into debt.”
The report comes as Americans casting their ballots in the November 3 midterm electionsidentify healthcare as a key issue amid a broader affordability crisis that Trump has repeatedly dismissed as a “hoax” perpetrated by his political opponents.
According to the Commonwealth Fund’s survey, 73% of US adults “believe the federal government has a responsibility to ensure all Americans have coverage, including 45% of Republicans, 93% of Democrats, and 76% of independents.” That finding is consistent with an earlier poll from the health policy group KFF showing that two-thirds of the American public has a favorable view of Medicare for All.
Trump has publicly and misleadingly attacked Medicare for All while insisting—without providing any specifics—that he intends to pass “a truly great healthcare plan” if the GOP retains control of Congress next month.
Trump has also touted small, one-time healthcare rebate checks that his administration has sent out to some Americans ahead of the midterms. The checks pale in comparison to the healthcare cost increases facing tens of millions of Americans.
Leslie Dach, chair of the advocacy group Protect Our Care, said in response to the Commonwealth Fund report that “Trump and Republicans are taking this country backward.”
“Families are facing skyrocketing premiums, mounting medical bills, and going without coverage altogether,” said Dach. “They’re being forced to put off seeing a doctor, skip prescriptions, or gamble with their health because they can’t afford care. And it’s only going to get worse as millions more Americans are expected to lose their health insurance as the full force of Republican cuts takes hold.”
“This is a damning report on Donald Trump and Republicans’ healthcare agenda, which is making it harder to afford and access care for working families across the country,” Dach added. “The only way to fix this is through the choices that Americans make in November.”
The Commonwealth Fund report came as KFF found that American workers now pay around $7,470 per year on average for employer-sponsored family health coverage—an increase of 9% compared to 2025.
“We have been hearing a lot about Affordable Care Act and Medicaid cuts,” said KFF president and CEO Drew Altman. “Now add a 9% increase in what workers with employer coverage paid toward family premiums in 2026 to the reasons voters are so concerned about their healthcare costs.”