According to the Census Bureau report “Health Insurance Coverage in the United States: 2020,” 8.6% of people did not have health insurance at all last year. That is a total of 28 million people. Who are these people? According to the Kaiser Family Foundation, “non-elderly” adults who are in working families.
Using data from the U.S. Census Bureau, 24/7 Wall St. identified the county with the best health insurance coverage. Counties are ranked on the share of residents under age 65 (the age of eligibility for Medicare) who are uninsured.
Most of the counties with the best life insurance were primarily in the Midwest and Northeast. Over half of the 14 counties in Massachusetts rank high, largely because the state was a national leader in health care reform, enacting laws that led to near-universal coverage almost half a decade before the Affordable Care Act was signed into law under the Obama administration.
The county with the best health insurance coverage is Norfolk County, Massachusetts. Here are the details:
- Adults under 65, no health insurance: 2.1%
- Adults under 65, Medicare coverage (or multiple types): 1.8% (215th lowest of 2,946 counties)
- Adults under 65, Medicaid coverage (or multiple types): 14.6% (493rd lowest)
- Adults under 65, VA coverage (or multiple types): 0.5% (166th lowest)
- Adults under 65, employer-based insurance (or multiple types): 77.5% (27th highest)
- Adults under 65, direct-purchase insurance (or multiple types): 10.6% (1,186th highest)
- Adults under 65, Tricare/military insurance (or multiple types): 0.6% (282nd lowest)
Methodology: To determine the county with the best health insurance coverage in the nation, 24/7 Wall St. reviewed five-year estimates of the percentage of the noninstitutionalized civilian population under 65 without health insurance from the Census Bureau’s 2019 American Community Survey (ACS).
Of the 3,220 counties or county-equivalents, 3,142 had boundaries that fell within one of the 50 states or the District of Columbia.
Counties were excluded if the noninstitutionalized civilian population under 65 was less than 1,000, or if the sampling error associated with a county’s data was deemed too high.
The sampling error was defined as too high if the coefficient of variation (a statistical assessment of how reliable an estimate is) for a county’s under 65 uninsured rate was above 15% and greater than two standard deviations above the mean coefficient of variation for all counties’ under 65 uninsured rates. We similarly excluded counties that had a sampling error too high for their under 65 noninstitutionalized civilian population, using the same definition.
We selected the under 65 age group because Americans become eligible for Medicare at age 65, and the uninsured rate for the population above this age is less than 1% nationwide. However, because the Census Bureau does not publish insurance coverage estimates specifically for the under 65 age group, we aggregated the data from more granular age breakdowns.
To ensure each aggregate estimate’s sampling error could be assessed using the definition above, we derived a margin of error for each aggregate estimate using the successive differences replication variance estimation methodology recommended and used by the Census Bureau.
The remaining 2,946 places were ranked based on their under 65 uninsured rates. To break ties, we used the number of insured people in the same population group.
The shares of the population covered by each type of insurance (Medicare, Medicaid, VA, employer, direct-purchase and Tricare/military) are for the same cohort and are also aggregated from five-year ACS estimates. The estimates reflect people who are covered by that type of insurance alone or in combination with other types on the list. So, when a person is covered by more than one type of insurance, they are included in each group.