The share of Americans under the age of 65 without health insurance fell every year between 2010, when the Affordable Care Act was signed into law, and 2016, when President Barack Obama left office. Though the U.S. uninsured rate among Americans younger than 65 has inched up over the years since, it remains well below the reported 17%+ figures in the years leading up to the ACA.
Without a universal health care program, most Americans under age 65 receive employer-based health insurance coverage. Under this system, 10.8% of Americans younger than 65, approximately 29 million people, lacked health insurance in 2019 — and that was before the COVID-19 pandemic put over 22 million Americans out of work.
While most of those jobs have since been restored, the official uninsured rate for Americans younger than 65 for 2020 will likely be higher than the 2019 rate. And in some parts of the country, the 2019 rate was already close to or above the higher national uninsured rates of the era before the passing of the ACA.
Using data from the U.S. Census Bureau, 24/7 Wall St. identified the metropolitan area in every state with the worst health insurance coverage. Metro areas are ranked based on the share of residents under age 65 — the age of eligibility for Medicare — who are uninsured. It is important to note that Delaware, New Hampshire, Rhode Island, and Vermont each have only one metropolitan area, and as a result, these places rank as having the worst health insurance coverage by default only.
Uninsured rates vary considerably across the country, and as a result, a metro area’s ranking on this list does not necessarily mean the uninsured rate is high relative to the nation as a whole. In over a dozen states, particularly in New England and parts of the Midwest, the highest uninsured rate among counties is in the single digits. Uninsured rates in the metropolitan areas on this list range from 4.1% to 35.7%. In comparison, here is the metro with the best health insurance in every state.