16 States With the Worst Rates of Health Insurance

Uninsured patient in a hospital room
Marcos Mesa Sam Wordley / Shutterstock.com

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 “15 States Where the Most People Have Health Insurance.”

15. Missouri (tie)

St. Louis, Missouri
Joseph Sohm / Shutterstock.com

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)

Las Cruces, New Mexico
VentureD / Shutterstock.com

It’s not just health insurance rates that could be better in New Mexico. A 2021 WalletHub analysis ranked it as the worst state in the nation for families, as we detail in “The Best and Worst States for Raising a Family in 2021.”

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

Tennessee
CrackerClips Stock Media / Shutterstock.com

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 was a trend 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

Sharon Day / Shutterstock.com

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)

Boise, Idaho
By Charles Knowles / Shutterstock.com

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)

Charleston, South Carolina
Bf11photo / Shutterstock.com

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)

Sedona, Arizona
DBSOCAL / Shutterstock.com

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)

Margaret.W / Shutterstock.com

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

Lake Tahoe
By Adonis Villanueva / Shutterstock.com

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

Mountain range and railroad track in Denali National Park, Alaska
Martina Birnbaum / Shutterstock.com

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

Snowmobilers pass a bison in Wyoming
Carolina K. Smith MD / Shutterstock.com

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

Mississippi road sign
Peek Creative Collective / Shutterstock.com

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

  • 2019: 13.0%
  • 2018: 12.1%
  • 2010: 18.2%

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

4. Florida

Orlando, Florida
ESB Professional / Shutterstock.com

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

  • 2019: 13.2%
  • 2018: 13.0%
  • 2010: 21.3%

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

3. Georgia

Columbus, Georgia skyline
Sean Pavone / Shutterstock.com

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

2. Oklahoma

4kclips / Shutterstock.com

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

Aneese / Shutterstock.com

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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