16 States With the Worst Rates of Health Insurance

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Health insurance isn’t a guarantee that you won’t end up stuck with big medical bills, but it can help reduce the chances that a major illness or injury could push you into bankruptcy court.

In 2019, 9.2% of U.S. residents were without health insurance coverage, according to the latest data from the U.S. Census Bureau.

Not every state has the same share of residents without insurance, however. This statistic for each state ranges from a high of 18.4% to a low of 3%.

Following is a look at the states with the largest shares of uninsured residents.

For a ranking of the states with the smallest shares of uninsured residents, check out “14 States Where the Most People Have Health Insurance.”

15. Missouri (tie)

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The Affordable Care Act of 2010 gave states the option to expand Medicaid eligibility to people whose income was below a particular threshold. Missouri, like most states on this list, is among more than a dozen states that had not expanded its Medicaid program as of Jan. 1, 2019, the Census Bureau reports.

Medicaid is a joint federal and state health insurance program that covers people with low incomes or disabilities.

Share of the state’s population without health insurance coverage in:

  • 2019: 10%
  • 2018: 9.4%
  • 2010: 13.2%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

15. New Mexico (tie)

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It’s not just health insurance rates that could be better in New Mexico. A 2020 WalletHub analysis ranked it as the worst state in the nation for families, as we detail in “The 10 Best and 10 Worst States for Raising a Family in 2020.”

Share of the state’s population without health insurance coverage in:

  • 2019: 10%
  • 2018: 9.5%
  • 2010: 19.6%

State’s Medicaid expansion status as of Jan. 1, 2019: Expanded eligibility

14. Tennessee

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Between 2010, when former President Barack Obama signed the Affordable Care Act into law, and 2019, the share of Tennessee residents without insurance fell 4.2%. The Census Bureau notes that this trend stands nationwide:

“All states and the District of Columbia had a lower uninsured rate in 2019 than in 2010.”

Share of the state’s population without health insurance coverage in:

  • 2019: 10.1%
  • 2018: 10.1%
  • 2010: 14.4%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

13. South Dakota

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South Dakota has the dubious distinction of having the lowest average annual wage for registered nurses of any state in the country, as we report in “How Much Nurses Get Paid in Every State.”

Share of the state’s population without health insurance coverage in:

  • 2019: 10.2%
  • 2018: 9.8%
  • 2010: 12.4%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

11. Idaho (tie)

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Share of the state’s population without health insurance coverage in:

  • 2019: 10.8%
  • 2018: 11.1%
  • 2010: 17.7%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

11. South Carolina (tie)

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Share of the state’s population without health insurance coverage in:

  • 2019: 10.8%
  • 2018: 10.5%
  • 2010: 17.5%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

9. Arizona (tie)

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Share of the state’s population without health insurance coverage in:

  • 2019: 11.3%
  • 2018: 10.6%
  • 2010: 16.9%

State’s Medicaid expansion status as of Jan. 1, 2019: Expanded eligibility

9. North Carolina (tie)

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Share of the state’s population without health insurance coverage in:

  • 2019: 11.3%
  • 2018: 10.7%
  • 2010: 16.8%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

8. Nevada

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Share of the state’s population without health insurance coverage in:

  • 2019: 11.4%
  • 2018: 11.2%
  • 2010: 22.6%

State’s Medicaid expansion status as of Jan. 1, 2019: Expanded eligibility

7. Alaska

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Share of the state’s population without health insurance coverage in:

  • 2019: 12.2%
  • 2018: 12.6%
  • 2010: 19.9%

State’s Medicaid expansion status as of Jan. 1, 2019: Expanded eligibility

6. Wyoming

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The Census Bureau report notes that Wyoming saw the largest increase in residents who are uninsured from 2018 to 2019 — 1.8 percentage points. A total of 19 states saw such an increase, although it was less than 1 percentage point in the other states.

Share of the state’s population without health insurance coverage in:

  • 2019: 12.3%
  • 2018:10.5%
  • 2010: 14.9%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

5. Mississippi

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Share of the state’s population without health insurance coverage in:

  • 2019: 13%
  • 2018: 12.1%
  • 2010: 18.2%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

4. Florida

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Share of the state’s population without health insurance coverage in:

  • 2019: 13.2%
  • 2018: 13%
  • 2010: 21.3%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

3. Georgia

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Share of the state’s population without health insurance coverage in:

  • 2019: 13.4%
  • 2018: 13.7%
  • 2010: 19.7%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

Georgia is one of the 18 states that haven’t expanded their Medicaid programs since passage of the Affordable Care Act in 2010.

2. Oklahoma

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Share of the state’s population without health insurance coverage in:

  • 2019:14.3%
  • 2018: 14.2%
  • 2010: 18.9%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

1. Texas

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Share of the state’s population without health insurance coverage in:

  • 2019: 18.4%
  • 2018: 17.7%
  • 2010: 23.7%

State’s Medicaid expansion status as of Jan. 1, 2019: Not expanded

Disclosure: The information you read here is always objective. However, we sometimes receive compensation when you click links within our stories.

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