Special Report

The City With the Worst Health Insurance Coverage in Every State

Nearly half of all Americans with health insurance receive coverage through their employer. When the COVID-19 pandemic hit, however, millions of Americans lost their jobs, and nearly 30% of U.S. residents lost their health insurance coverage. While many have returned to employment, health insurance coverage levels are likely still far from the pre-pandemic normal. 

It remains to be seen how much of an impact the pandemic has truly had on health coverage in the United States, but there are a number of American cities where even a small loss of insurance coverage would have driven already low coverage levels even lower, certainly below the national figure.

According to the five-year average through 2019, the most recent year for which data is available through the U.S. Census, 10.3% of Americans did not have health insurance coverage. In many American cities, the uninsured rate was far greater, and a number of cities had more than double the uninsured share. 

To determine the cities with the worst health insurance coverage in every state, 24/7 Wall St. reviewed five-year estimates of the percentage of the noninstitutionalized civilian population under 65 without health insurance from the U.S. Census Bureau’s 2019 American Community Survey. We looked at the population under 65 because Americans 65 and older are automatically entitled to Medicare benefits. It should be noted that Burlington is the only city in Vermont that meets the population requirements and therefore is the least insured city in the state by default, despite having a relatively highly-insured population. 

Health insurance coverage varies substantially from state to state. While, as might be expected, the city in each state with the worst health insurance coverage generally has worse coverage than the national average, there are seven states, not counting Vermont, where in the city with the worst coverage fewer than 10.3% of residents lack health insurance coverage. 

Among the other cities to make this list, generally it is the case that in states with worse insurance coverage of the under 65 population, the city to make this list has especially poor health insurance coverage. Texas has the highest uninsured rate in the country, at 19.4% of the population under 65. The city of San Juan in Texas has the third highest uninsured rate of any place to qualify for this ranking, at 37.2%. 

Click here to see the city with the worst health insurance coverage in every state.
Click here to see our methodology.