Cuts to federal programs and the loss of enhanced subsidies on the exchanges could deepen an existing healthcare affordability crisis, according to a new report from the Commonwealth Fund.

The Commonwealth Fund, which surveyed over 9,300 adults aged 19-64, also found that almost half of working-age adults have inadequate insurance this year, meaning that they either were uninsured, had a gap in coverage or had unaffordable health coverage.

In addition to the 11% of uninsured adults, 12% experienced a gap in insurance coverage this year and 23% are underinsured, according to the report.

These trends coincide with the expiration of the Affordable Care Act premium subsidies and the end of pandemic-era Medicaid coverage protections. Fewer adults are now enrolled in both exchange plans and Medicaid coverage, the report says.

More cuts to Medicaid are coming, which are expected to increase the uninsured rate. Starting next year, Medicaid enrollees will be required to log 80 hours of work, schooling or volunteering to maintain coverage. Paired with more frequent eligibility checks, the first national work requirement program in Medicaid is expected to cause up to 10 million people to lose coverage.

Affordability challenges for all Americans will only get worse with those coverage losses, according to Sara R. Collins, the lead study author and senior scholar at the Commonwealth Fund.

“Stripping insurance from millions of people will deepen an affordability crisis that already leaves too many going without care or paying off medical debt,” Collins said in a press release.

The rise in the uninsured rate could lead more patients to skip care.

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