States With the Highest Rates of Uninsured Residents

Across the US, the states’ rates of uninsured individuals can vary dramatically. While all states have made gains in covering individuals, some have lagged behind. Before the implementation of the Affordable Care Act, the country’s overall uninsured rate was 17.3% in 2013, but in the first half of 2015 the uninsured rate fell to 11.7%, according to Gallup.

An analysis from WalletHub of the uninsured rates in each state, plus the District of Columbia, after the implementation of the ACA found red states have higher rates of uninsured compared with blue states. Red states also tended to resist expanding Medicaid coverage. The average uninsured rate for states that did not expand Medicaid is 12.74% compared with 9.35% for states that did expand the federal program under the ACA.

States in the South tend to have the highest rates of uninsured, while the Midwest and the Northeast had the lowest rates.

WalletHub used absolute difference—the difference between the percentage of uninsured/insured in 2014 and 2010—and relative difference—the percentage of uninsured that was reduced to bring the uninsured rate to zero, which was calculated as such:

(Uninsured Rate in 2014 — Uninsured Rate in 2010) / (0 - Uninsured Rate in 2010)

The data used to create the rankings were obtained from the US Census Bureau.

Here are the states that had the lowest uninsured rates in 2014. (See the states with the lowest uninsured rates.)

Highest Uninsured Rates

Ranking includes District of Columbia, so there are 51 total entries

47. Oklahoma

Uninsured rate in 2014: 15.36%

The difference between the uninsured rate in 2014 compared with 2010 is -3.50% for Oklahoma, which isn’t too far off from the national average (-3.80%). However, it still has one of the highest uninsured rates in the country.

The state did a better job of lowering the uninsured rate among adults (-4.27%, which ranks 18) compared with children (-1.30%, which ranks 30). Similarly, the difference in uninsured between blacks and whites ranks better (29, 5.28%) than the difference between Hispanics and whites (ranked 36, 18.58%).

Oklahoma has one of the worst disparities when it comes to the uninsured rates based on income, which is likely due to the fact that the state did not expand Medicaid. While the uninsured rate for high-income households was one of the worst (6.31%), so was the rate for low-income households (21.48%). The difference in uninsured rates between the 2 ranked 47 overall at 15.17%.

While the lack of Medicaid expansion meant Oklahoma had a small difference in the public health insurance rate in 2014 compared to 2010 (1.81%, ranked 40), Oklahoma actually had one of the better performances in private insurance coverage. The difference in the private insurance rate ranked 7 (1.69%).

48. Georgia

Uninsured rate in 2014: 15.83%

Like Oklahoma, the difference in Georgia’s uninsured rate in 2014 compared with 2010 (3.87%) is close to the national difference. The Peach State did better than the national average for both the difference in children’s uninsured rate (-2.19) and the adult uninsured rate (-4.62%).

Racial/ethnicity disparities remain in issue in Georgia, though. The state has the third-worst difference in uninsured rate between Hispanics and whites (25.20%) and was just below the national average when it came to the difference of the uninsured rates between blacks and whites (5.97%).

The uninsured rate situation was even worse when considering income. Georgia had the second-largest difference in uninsured rate between low-income and high-income households (17.69%).

49. Florida

Uninsured rate in 2014: 16.57%

Florida actually made huge progress. The difference in the uninsured rate between 2014 and 2010 is -4.69, which ranks 11 overall and is much better than the national average. Even though the uninsured rates for children and adults are among the worst in the country, the difference in those rates between 2014 and 2010 are among some of the best in the nation.

Florida ranked better for the difference in uninsured rate between Hispanics and whites (23, 13.59%) compared with the difference between blacks and whites (42, 6.98%). However, it has a large income disparity, with the difference in uninsured rate between low-income and high-income households (14.86%) ranked 46.

In Florida the rate of individuals with employer-based health insurance went down slightly from 45.19% in 2010 to 44.99% in 2014, which makes it 1 of only 12 states that had a negative change in employer-based health insurance.

50. Alaska

Uninsured rate in 2014: 17.21%

Alaska is the only state that did choose to expand Medicaid, but its uninsured rate remains high despite that decision. The northernmost state in the US has the highest uninsured rate for children (11.41%) and the second-highest rate for adults (19.26%).

Alaska has made progress, though. The absolute difference in uninsured in 2014 compared with 2010 is -2.65%, which ranks 34 in the country.

As far as race/ethnicity disparities go, Alaska is right around the national average, with a difference in uninsured rates between Hispanics and whites of 14.24% and the difference between blacks and whites at 5.89%.

The state may have the second-worst uninsured rate among low-income households (23.97%) and the worse for high-income households (11.05%), but the difference between the 2 of them ranks 32 (12.92%), which isn’t too far off from the national average (12.29%).

51. Texas

Uninsured rate in 2014: 19.06%

Like Florida, Texas has actually made huge progress. The difference in the uninsured rate was -4.65% from 2010 to 2014. The adult uninsured rate is the only one in the country to top 20%, and the children’s uninsured rate is 1 of only 2 to top 11%.

In Texas, the difference in uninsured rate between blacks and whites (5.29%) is slightly better than the national average, although it ranked worse for the difference between Hispanics and whites (ranked 37, 19.15%).

The state performed even worse when WalletHub analyzed the uninsured rate by income. The difference between low-income households and high-income households was 20%, by far the worst in the whole country, and well above the national average of 12.29%.

Texas actually had the best difference in the private health insurance rate (3.02%), although it had one of the worst differences in the public health insurance rate (1.63%). The difference in the employer-based health insurance rate between 2014 and 2010 was the fourth-best in the country (2.85%), although it had one of the lowest rates overall (49.09% in 2014, ranked 42).