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 uninsured rate among Americans younger than 65 has inched up over the years since, it remains well below the 17%+ figures in the years leading up to the ACA. 

Without a universal health care program, employer-based health insurance covers most Americans under age 65. Under this system, 10.3% of Americans younger than 65, approximately 25 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 2020 uninsured rate for Americans under 65 will likely be higher than the 2019 rate, which, in some parts of the country, was already well above the national uninsured rate levels from before the passing of the ACA. 

Using data from the U.S. Census Bureau, 24/7 Tempo identified the 50 towns with the worst health insurance coverage. Towns are ranked based on the share of residents under age 65 — the age of eligibility for Medicare — who are uninsured. We included cities, towns, villages, and unincorporated communities with populations between 1,000 and 25,000 in our analysis. 

Uninsured rates in the places on this list range from 39.5% to nearly 60%. The majority of the towns on this list are in Southern states, including 26 in Texas alone. 

Click here to see the towns with the worst health insurance coverage in the nation
Click here to see our detailed methodology