Health Insurance
Uninsured Rates Rise in 26 States Over Past Year but Are Down Slightly Across US
The national uninsured rate has dipped slightly over the past year. According to a ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data, 7.5% of Americans are without health insurance coverage, down 3.8% from last year’s 7.8%.
Health insurance has figured prominently in headlines throughout 2023 as the Medicaid continuous coverage requirement ended at the end of March — a move the U.S. Department of Health and Human Services called the "single largest health coverage transition event since the first open enrollment period of the Affordable Care Act."
While the uninsured rate remains relatively static nationwide, the figure varies widely on a state-by-state basis. Our analysis examines both.
On this page
- Key findings
- National uninsured rate dips 3.8% over past year
- 5 states have uninsured rates higher than 10.0%, led by Mississippi
- District of Columbia, Connecticut at least double uninsured rates in past year
- Delaware, Maryland half uninsured rates over past year
- Tips for finding health insurance
- Methodology
Key findings
- 7.5% of Americans report not having health insurance. That’s down modestly (3.8%) from 7.8% roughly a year earlier.
- 15.9% of Mississippians don’t have health insurance — more than double the national rate. The other states with uninsured rates above 10.0% are Texas (14.4%), Georgia (11.4%), Tennessee (11.2%) and Kansas (10.6%).
- In contrast, uninsured rates are about a third the size of the national rate in Maryland (2.7%) and Delaware (2.8%). Rhode Island and Hawaii are tied for the third-lowest rate, at 3.7% — just under half the national rate.
- The District of Columbia (175.0%) and Connecticut (100.0%) at least doubled their uninsured rate over the past year. Both had low rates in 2022 — 2.4% (second-lowest across the U.S.) and 2.8% (fourth-lowest), respectively. They now have the 23rd- and 36th-highest rates. Meanwhile, Vermont’s uninsured rate increased by 92.0% from 2.5% to 4.8%, tied for fifth-lowest.
- Delaware and Maryland more than halved their uninsured rates over the past year. Their uninsured rates went from 6.3% to 2.8% (down 55.6%) and 5.8% to 2.7% (down 53.4%), respectively. California saw the third-largest decrease — 38.9%, from 9.0% to 5.5%.
National uninsured rate dips 3.8% over past year
The uninsured rate dipped 3.8% nationally over the past year, with 7.5% of Americans reporting no coverage between Aug. 23 and Sept. 4, 2023 — as opposed to 7.8% between Sept. 14 and 26, 2022.
U.S. uninsured rate | |
|---|---|
| Uninsured rate, Sept. 14-26, 2022 | 7.8% |
| Uninsured rate, Aug. 23-Sept. 4, 2023 | 7.5% |
| % change | -3.8% |
Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data.
"The reduction in the number of Americans without health insurance is a reflection of the pandemic-era policies — like the adoption of Medicaid expansion under the Affordable Care Act in several states, as well as the continuous enrollment provision included in the Families First Coronavirus Response Act (FFCRA) — that incentivized states to keep people enrolled in Medicaid," ValuePenguin health insurance expert Divya Sangameshwar says.
These policies, which made it easier for Americans to enroll in and sustain their health coverage, paid off, Sangameshwar says, as the uninsured rate plummeted between 2021 and 2022. However, the downward trend is slowing — partly due to the end of those COVID-era policies.
5 states have uninsured rates higher than 10.0%, led by Mississippi
At the state level, however, uninsured rates vary substantially — often to the disadvantage of Americans needing health care. To wit, five states have uninsured rates of 10.0% or greater, with Mississippi leading the charge at 15.9%.
Runners-up include Texas, Georgia, Tennessee and Kansas, all of which, along with Mississippi, are states without expanded Medicaid, Sangameshwar notes.
"Residents here are also more likely to fall within a health care coverage gap by making too much money to qualify for Medicaid and too little to qualify for a subsidized Affordable Care Act plan," Sangameshwar says. "This alone could lead to an increase in the uninsured rates in these states when continuous enrollment ends."
States with uninsured rates above 10.0%
Rank | State | Uninsured rate |
|---|---|---|
| 1 | Mississippi | 15.9% |
| 2 | Texas | 14.4% |
| 3 | Georgia | 11.4% |
| 4 | Tennessee | 11.2% |
| 5 | Kansas | 10.6% |
Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data from Aug. 23 through Sept. 4, 2023.
Almost half of uninsured Mississippians cite coverage costs as the main reason for their lack of coverage, according to Altarum’s Consumer Healthcare Experience State Survey published on Healthcare Value Hub in August 2023. This is despite the average cost of health insurance in Mississippi being relatively low, at $499 a month, before subsidies, for a Silver plan. That makes Mississippi’s health insurance the 17th-cheapest in the country, Sangameshwar says.
"Seeing Mississippi rank so high and experience a 12.8% increase in their uninsured rate means that more needs to be done to make health insurance more accessible and affordable to the state’s residents," she concludes. Maryland, Delaware have uninsured rates about a third the national rate At the other end of the spectrum, some states boast uninsured rates a fraction of the national average — most notably Maryland, whose 2.7% uninsured rate is the lowest in our analysis and only about a third of the overall American rate of 7.5%.
Delaware comes in second with an uninsured rate of 2.8%, while Rhode Island and Hawaii are tied for third at 3.7%. Other states enjoying relatively low uninsured rates include Wisconsin, Vermont, Pennsylvania, New York and Michigan.
States with uninsured rates below 4.0%
Rank | State | Uninsured rate |
|---|---|---|
| 1 | Maryland | 2.7% |
| 2 | Delaware | 2.8% |
| 3 | Rhode Island | 3.7% |
| 3 | Hawaii | 3.7% |
Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data from Aug. 23 through Sept. 4, 2023.
"All the states with low uninsured rates have drastically different approaches that achieve the same aim," Sangameshwar says.
Maryland makes health insurance enrollment as easy as possible by including a checkbox on state tax returns, for example. Delaware offers its residents more insurer and plan choices than it used to — and also partially reimburses insurers for high-cost health care claims, Sangameshwar says.
Rhode Island uses an individual mandate system that results in fines for uninsured residents, while Hawaii requires employers to offer health care coverage to employees who work at least 20 hours a week, starting after four weeks of employment.
Full rankings
States with the highest/lowest uninsured rates
Rank | State | Uninsured rate |
|---|---|---|
| 1 | Mississippi | 15.9% |
| 2 | Texas | 14.4% |
| 3 | Georgia | 11.4% |
| 4 | Tennessee | 11.2% |
| 5 | Kansas | 10.6% |
| 6 | Nevada | 9.8% |
| 7 | Arkansas | 9.6% |
| 7 | Wyoming | 9.6% |
| 9 | Arizona | 9.5% |
| 9 | Oklahoma | 9.5% |
| 11 | Alabama | 9.4% |
| 12 | Utah | 9.3% |
Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data from Aug. 23 through Sept. 4, 2023.
District of Columbia, Connecticut at least double uninsured rates in past year
Despite the slight downward trend nationally, the uninsured rate has at least doubled in some parts of the country.
Over the past year, the District of Columbia’s uninsured rate leapt from 2.4% to 6.6%, a 175.0% increase. Connecticut saw its uninsured rate double from 2.8% to 5.6%. (Vermont just missed the cut with a 92.0% increase in its uninsured rate, moving from 2.5% to 4.8%.)
States with uninsured rate increases over the past year
Rank | State | Uninsured rate, September 2022 | Uninsured rate, August-September 2023 | Change (%) |
|---|---|---|---|---|
| 1 | District of Columbia | 2.4% | 6.6% | 175.0% |
| 2 | Connecticut | 2.8% | 5.6% | 100.0% |
| 3 | Vermont | 2.5% | 4.8% | 92.0% |
| 4 | Hawaii | 2.2% | 3.7% | 68.2% |
| 5 | Kansas | 6.5% | 10.6% | 63.1% |
| 6 | Missouri | 5.9% | 9.0% | 52.5% |
| 7 | Utah | 6.5% | 9.3% | 43.1% |
| 8 | Tennessee | 8.1% | 11.2% | 38.3% |
| 9 | Massachusetts | 3.9% | 5.3% | 35.9% |
| 10 | Ohio | 5.6% | 7.2% | 28.6% |
| 11 | New Hampshire | 4.8% | 6.1% | 27.1% |
| 12 | Wisconsin | 3.8% | 4.8% | 26.3% |
Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data from Sept. 14 through 26, 2022, and Aug. 23 through Sept. 4, 2023.
Because this data was gathered after the end of the Medicaid continuous coverage requirement but before the 2024 open enrollment period — which began on Nov. 1 — churn may affect these statistics. That’s to say, some patients may have been without coverage when the data was gleaned but plan on renewing coverage later in the year.
Delaware, Maryland half uninsured rates over past year
Some states saw an even greater decrease in their uninsured rate than the national average. In Delaware and Maryland, the rate was slashed in half. Delaware saw a drop from 6.3% to 2.8%, while Maryland’s uninsured rate dropped from 5.8% to 2.7%.
California also saw a significant drop (38.9%), and Louisiana came in fourth with an uninsured rate dip of 34.3%.
States with uninsured rate decreases over the past year
Rank | State | Uninsured rate, September 2022 | Uninsured rate, August-September 2023 | Change (%) |
|---|---|---|---|---|
| 1 | Delaware | 6.3% | 2.8% | -55.6% |
| 2 | Maryland | 5.8% | 2.7% | -53.4% |
| 3 | California | 9.0% | 5.5% | -38.9% |
| 4 | Louisiana | 9.9% | 6.5% | -34.3% |
| 5 | Alaska | 11.5% | 8.2% | -28.7% |
| 6 | Colorado | 10.2% | 7.3% | -28.4% |
| 7 | Idaho | 9.2% | 6.6% | -28.3% |
| 8 | Oklahoma | 13.1% | 9.5% | -27.5% |
| 9 | North Carolina | 8.5% | 6.3% | -25.9% |
| 10 | New Jersey | 6.8% | 5.4% | -20.6% |
| 11 | Pennsylvania | 5.6% | 4.8% | -14.3% |
| 12 | Virginia | 6.3% | 5.5% | -12.7% |
Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data from Sept. 14 through 26, 2022, and Aug. 23 through Sept. 4, 2023.
As discussed above, the strategies used by Delaware and Maryland to make enrollment easier for their residents likely play a part in their falling uninsured rate, even in the face of the end of the Medicaid continuous coverage requirement.
Only two states — New Mexico and Rhode Island — saw neither an increase nor a decrease in their uninsured rate over the past year, with New Mexico holding static at 6.6% and Rhode Island at 3.7%.
Tips for finding health insurance
Although it can be expensive, health insurance is also vital.
"Uninsured Americans have less access to recommended care, receive poorer quality of care and experience worse health outcomes than insured adults," Sangameshwar says. "Opting to remain or become uninsured is quite possibly the worst course of action."
If you or your loved ones are looking for coverage, here are some tips that can help reduce your overall health insurance costs:
- See if you qualify for Medicaid and/or the Children’s Health Insurance Program (CHIP). Many eligible low-income families don’t know they qualify for these low-cost programs.
- Speak with a professional. An insurance agent or broker can help you choose the right plan for your needs, including making sure you’re taking advantage of any subsidies for which you might qualify.
- Shop around — and don’t necessarily choose the lowest premium. If you’re struggling to make ends meet, choosing a plan with a more expensive premium can feel counterintuitive, but it may save you money in the long run. "Going for the ‘cheapest’ option when it comes to a health insurance plan can cost you thousands of dollars extra each year in unexpected medical expenses," says Sangameshwar, "especially if you aren’t looking at the whole picture when choosing a suitable health plan for you and your family."
- Write it down. Sangameshwar recommends writing a list of your specific medical needs and most-used services before shopping for a plan to ensure you get all the coverage you need when you choose one. Don’t forget to include prescription medications you take and any providers you trust, as you want to ensure they’re in-network.
Methodology
ValuePenguin researchers analyzed U.S. Census Bureau Household Pulse Survey data for weeks 61 (Aug. 23 through Sept. 4, 2023) and 49 (Sept. 14 through 26, 2022) to estimate the rates of residents covered by public, private or both kinds of health insurance and the rates of those without health insurance.
Respondents who didn’t know or didn’t report answers were excluded from this analysis.
