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
Source: Carol M. Highsmith, Public domain, via Wikimedia Commons
50. Rio Grande City, Texas
> Residents under 65, no health insurance: 39.5%
> Residents under 65, Medicare coverage (or multiple types): 2.0% — 3,270th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 30.6% — 2,903rd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.4% — 2,333rd lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 27.4% — 334th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.1% — 425th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.7% — 4,415th lowest of 11,039 towns
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Source: Flory / Getty Images
49. Arapahoe, Wyoming
> Residents under 65, no health insurance: 39.5%
> Residents under 65, Medicare coverage (or multiple types): 3.8% — 4,267th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 28.7% — 3,384th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.7% — 3,589th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 27.5% — 340th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.4% — 266th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.5% — 3,448th lowest of 11,039 towns
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Source: CG-Photos / iStock via Getty Images
48. Fort Pierce South, Florida
> Residents under 65, no health insurance: 39.7%
> Residents under 65, Medicare coverage (or multiple types): 0.5% — 493rd lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 15.1% — 3,542nd lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 38.0% — 1,182nd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 5.2% — 1,682nd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 2.0% — 3,161st highest of 11,039 towns
Source: RoschetzkyIstockPhoto / iStock / Getty Images Plus
47. Agua Dulce, Texas
> Residents under 65, no health insurance: 39.8%
> Residents under 65, Medicare coverage (or multiple types): 2.1% — 3,452nd lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 36.9% — 1,616th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.3% — 2,009th lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 14.0% — 32nd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 8.4% — 5,140th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.8% — 4,588th lowest of 11,039 towns
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Source: The original uploader was Skarg at English Wikipedia., CC BY 2.5 , via Wikimedia Commons
46. Lakeview Estates, Georgia
> Residents under 65, no health insurance: 39.9%
> Residents under 65, Medicare coverage (or multiple types): 0.6% — 612th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 32.6% — 2,429th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.2% — 1,477th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 23.5% — 184th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.4% — 1,090th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
45. Jemez Pueblo, New Mexico
> Residents under 65, no health insurance: 40.2%
> Residents under 65, Medicare coverage (or multiple types): 2.2% — 3,765th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 37.2% — 1,570th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.3% — 4,502nd highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 23.9% — 198th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.1% — 28th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.2% — 2,287th lowest of 11,039 towns
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Source: Chester Leeds / iStock via Getty Images
44. Elm Creek, Texas
> Residents under 65, no health insurance: 40.5%
> Residents under 65, Medicare coverage (or multiple types): 0.4% — 350th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 19.0% — 4,763rd lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 33.1% — 723rd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 7.5% — 4,100th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Daniel Mayer / Wikimedia Commons
43. Doraville, Georgia
> Residents under 65, no health insurance: 40.6%
> Residents under 65, Medicare coverage (or multiple types): 1.7% — 2,569th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 18.8% — 4,698th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.7% — 3,714th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 30.8% — 547th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 9.0% — 5,242nd highest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.3% — 4,743rd highest of 11,039 towns
Source: dhughes9 / iStock via Getty Images
42. Skidmore, Texas
> Residents under 65, no health insurance: 40.6%
> Residents under 65, Medicare coverage (or multiple types): 4.9% — 2,795th highest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 24.6% — 4,473rd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.6% — 3,375th highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 34.8% — 861st lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.0% — 838th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.8% — 4,711th lowest of 11,039 towns
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Source: usdagov / Flickr
41. Bloomington, Texas
> Residents under 65, no health insurance: 40.6%
> Residents under 65, Medicare coverage (or multiple types): 1.7% — 2,530th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 15.7% — 3,721st lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 2.0% — 2,243rd highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 33.3% — 739th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.4% — 568th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 3.3% — 1,646th highest of 11,039 towns
Source: By NatalieMaynor from Jackson, Mississippi, USA - Pine Ridge CemeteryUploaded by AlbertHerring, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=29464149 / Wikimedia Commons
40. Conehatta, Mississippi
> Residents under 65, no health insurance: 40.8%
> Residents under 65, Medicare coverage (or multiple types): 0.8% — 887th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 32.3% — 2,510th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 28.7% — 408th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.4% — 35th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Danny20111993 / Wikimedia Commons
39. Scissors, Texas
> Residents under 65, no health insurance: 40.9%
> Residents under 65, Medicare coverage (or multiple types): 0.8% — 968th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 47.2% — 530th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 9.9% — 13th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 1.9% — 167th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Art Wager / Getty Images
38. Broadview Park, Florida
> Residents under 65, no health insurance: 41.0%
> Residents under 65, Medicare coverage (or multiple types): 1.1% — 1,401st lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 30.3% — 2,983rd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.5% — 2,620th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 20.6% — 125th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 8.7% — 5,490th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.5% — 3,683rd lowest of 11,039 towns
Source: Georgia Guercio / Wikimedia Commons
37. Tice, Florida
> Residents under 65, no health insurance: 41.1%
> Residents under 65, Medicare coverage (or multiple types): 2.7% — 4,654th lowest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 25.6% — 4,217th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.4% — 2,113th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 25.5% — 247th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 10.2% — 3,984th highest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Volodymyr Cheppel / iStock via Getty Images
36. Pine Ridge, South Dakota
> Residents under 65, no health insurance: 41.4%
> Residents under 65, Medicare coverage (or multiple types): 1.7% — 2,518th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 41.6% — 999th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 2.2% — 1,885th highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 18.0% — 77th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.0% reported — 27th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
Source: BOB WESTON / iStock via Getty Images
35. Shepherd, Texas
> Residents under 65, no health insurance: 41.4%
> Residents under 65, Medicare coverage (or multiple types): 4.7% — 3,071st highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 23.4% — 4,857th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.2% — 1,442nd lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 32.4% — 669th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.1% — 869th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: 64860478@N05 / Flickr
34. Chula Vista (Maverick County), Texas
> Residents under 65, no health insurance: 42.7%
> Residents under 65, Medicare coverage (or multiple types): 1.3% — 1,794th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 20.8% — 5,338th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.3% — 1,912th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 32.3% — 665th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.3% — 543rd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.3% — 2,690th lowest of 11,039 towns
Source: Jaedza / Wikimedia Commons
33. Olmito, Texas
> Residents under 65, no health insurance: 42.9%
> Residents under 65, Medicare coverage (or multiple types): 1.6% — 2,465th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 10.5% — 2,068th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 2.0% — 2,244th highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 43.9% — 2,020th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 1.3% — 98th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 4.6% — 972nd highest of 11,039 towns
Source: Theunderratedtaco, CC BY-SA 4.0 , via Wikimedia Commons
32. Progreso, Texas
> Residents under 65, no health insurance: 43.3%
> Residents under 65, Medicare coverage (or multiple types): 0.6% — 607th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 28.3% — 3,495th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.9% — 4,637th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 27.7% — 348th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.7% — 50th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: JERRYE & ROY KLOTZ M.D., CC BY-SA 4.0 , via Wikimedia Commons
31. Eidson Road, Texas
> Residents under 65, no health insurance: 43.4%
> Residents under 65, Medicare coverage (or multiple types): 1.2% — 1,512th lowest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 27.9% — 3,610th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.4% — 2,546th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 25.9% — 267th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.4% — 256th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
30. King Cove, Alaska
> Residents under 65, no health insurance: 43.9%
> Residents under 65, Medicare coverage (or multiple types): 0.7% — 724th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 19.8% — 5,039th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.3% — 1,783rd lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 34.4% — 817th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.4% — 260th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Harry Weddington, U.S. Army Corps of Engineers / Wikimedia Commons
29. Fort Thompson, South Dakota
> Residents under 65, no health insurance: 44.0%
> Residents under 65, Medicare coverage (or multiple types): 7.5% — 808th highest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 45.2% — 670th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.9% — 4,965th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 6.3% — 1st lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.8% — 52nd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.3% — 2,817th lowest of 11,039 towns
28. Cherokee, North Carolina
> Residents under 65, no health insurance: 44.0%
> Residents under 65, Medicare coverage (or multiple types): 5.1% — 2,563rd highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 15.9% — 3,787th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.6% — 3,051st lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 36.0% — 976th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 1.0% — 71st lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.1% — 5,273rd highest of 11,039 towns (tied)
Source: ALAN SCHMIERER / Wikimedia Commons
27. Roma, Texas
> Residents under 65, no health insurance: 44.0%
> Residents under 65, Medicare coverage (or multiple types): 4.1% — 3,895th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 33.4% — 2,272nd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.6% — 3,407th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 17.4% — 72nd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.0% — 818th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.2% — 2,194th lowest of 11,039 towns
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Source: Larry D. Moore / Wikimedia Commons
26. West Orange, Texas
> Residents under 65, no health insurance: 44.3%
> Residents under 65, Medicare coverage (or multiple types): 5.6% — 1,983rd highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 21.9% — 5,334th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.9% — 4,596th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 28.9% — 425th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.6% — 1,218th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.1% — 5,253rd highest of 11,039 towns
Source: Larry D. Moore, CC BY-SA 3.0 , via Wikimedia Commons
25. Pinehurst, Texas
> Residents under 65, no health insurance: 44.5%
> Residents under 65, Medicare coverage (or multiple types): 4.3% — 3,507th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 25.9% — 4,132nd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.2% — 1,473rd lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 29.3% — 453rd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.3% — 1,006th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.9% — 3,325th highest of 11,039 towns
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Source: DenisTangneyJr / iStock via Getty Images
24. Penitas, Texas
> Residents under 65, no health insurance: 44.6%
> Residents under 65, Medicare coverage (or multiple types): 2.4% — 4,117th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 24.3% — 4,568th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 24.4% — 214th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 6.7% — 3,242nd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
Source: Danny20111993 at English Wikipedia, CC BY-SA 3.0 , via Wikimedia Commons
23. Alton, Texas
> Residents under 65, no health insurance: 44.7%
> Residents under 65, Medicare coverage (or multiple types): 1.0% — 1,292nd lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 31.5% — 2,709th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.3% — 1,850th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 19.7% — 104th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 7.4% — 4,002nd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.1% — 1,818th lowest of 11,039 towns
Source: Courtesy of Google Maps 2014
22. Ethete, Wyoming
> Residents under 65, no health insurance: 44.8%
> Residents under 65, Medicare coverage (or multiple types): 2.0% — 3,333rd lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 31.5% — 2,687th highest of 11,039 towns (tied)
> Residents under 65, VA coverage (or multiple types): 0.9% — 4,665th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 21.8% — 147th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.9% — 61st lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.2% — 2,267th lowest of 11,039 towns
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Source: RiverNorthPhotography / iStock via Getty Images
21. Crow Agency, Montana
> Residents under 65, no health insurance: 45.1%
> Residents under 65, Medicare coverage (or multiple types): 1.6% — 2,447th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 41.8% — 980th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.5% — 3,789th highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 13.0% — 27th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.8% — 56th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
20. Lame Deer, Montana
> Residents under 65, no health insurance: 45.4%
> Residents under 65, Medicare coverage (or multiple types): 0.7% — 805th lowest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 28.6% — 3,413th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.4% — 4,231st highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 23.2% — 178th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 6.2% — 2,681st lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.0% — 5,495th highest of 11,039 towns
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Source: Public Domain / Wikimedia Commons
19. Aldine, Texas
> Residents under 65, no health insurance: 45.4%
> Residents under 65, Medicare coverage (or multiple types): 1.5% — 2,195th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 33.6% — 2,222nd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.2% — 1,422nd lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 18.5% — 85th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.8% — 365th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
Source: Carol M. Highsmith / Public Domain / Wikimedia Commons
18. Las Lomas, Texas
> Residents under 65, no health insurance: 45.5%
> Residents under 65, Medicare coverage (or multiple types): 5.3% — 2,328th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 38.7% — 1,350th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 14.7% — 40th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.6% — 640th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
17. Langley Park, Maryland
> Residents under 65, no health insurance: 46.0%
> Residents under 65, Medicare coverage (or multiple types): 0.4% — 433rd lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 35.1% — 1,938th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.2% — 1,198th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 15.9% — 54th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.3% — 529th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1,779th lowest of 11,039 towns
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16. Port Isabel, Texas
> Residents under 65, no health insurance: 46.3%
> Residents under 65, Medicare coverage (or multiple types): 3.9% — 4,075th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 22.0% — 5,297th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.7% — 3,835th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 24.2% — 209th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 6.2% — 2,687th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.4% — 3,015th lowest of 11,039 towns
Source: Ebyabe / Wikimedia Commons
15. Suncoast Estates, Florida
> Residents under 65, no health insurance: 46.4%
> Residents under 65, Medicare coverage (or multiple types): 4.7% — 3,021st highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 34.8% — 1,996th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.3% — 4,451st highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 16.8% — 64th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 4.5% — 1,176th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.5% — 4,135th highest of 11,039 towns
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Source: Larry Felton Johnson, Cobb County Courier / Wikimedia Commons
14. Fair Oaks, Georgia
> Residents under 65, no health insurance: 46.9%
> Residents under 65, Medicare coverage (or multiple types): 6.0% — 1,702nd highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 22.1% — 5,269th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.2% — 1,520th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 21.5% — 140th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 5.1% — 1,625th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 1.8% — 3,451st highest of 11,039 towns
13. Menard, Texas
> Residents under 65, no health insurance: 46.9%
> Residents under 65, Medicare coverage (or multiple types): 6.3% — 1,474th highest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 16.2% — 3,854th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 2.0% — 2,367th highest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 28.8% — 416th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 11.6% — 2,877th highest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 2.0% — 3,126th highest of 11,039 towns (tied)
Source: Courtesy of Google Maps 2011
12. La Homa, Texas
> Residents under 65, no health insurance: 47.1%
> Residents under 65, Medicare coverage (or multiple types): 2.6% — 4,521st lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 31.2% — 2,755th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.1% — 1,072nd lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 15.4% — 51st lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 6.9% — 3,377th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Mplfan, CC BY-SA 4.0 , via Wikimedia Commons
11. Palmview, Texas
> Residents under 65, no health insurance: 47.5%
> Residents under 65, Medicare coverage (or multiple types): 7.6% — 776th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 20.0% — 5,085th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.9% — 2,608th highest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 18.4% — 83rd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 11.2% — 3,177th highest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.2% — 2,259th lowest of 11,039 towns
Source: formulanone / Flickr
10. Escobares, Texas
> Residents under 65, no health insurance: 48.0%
> Residents under 65, Medicare coverage (or multiple types): 3.8% — 4,331st highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 38.7% — 1,347th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.3% — 1,656th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 10.1% — 16th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.2% — 464th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: JannHuizenga / iStock Unreleased via Getty Images
9. Santo Domingo Pueblo, New Mexico
> Residents under 65, no health insurance: 48.2%
> Residents under 65, Medicare coverage (or multiple types): 3.2% — 5,288th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 39.4% — 1,248th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.8% — 4,259th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 11.3% — 19th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: Arpad Benedek / iStock via Getty Images
8. Cameron Park, Texas
> Residents under 65, no health insurance: 48.7%
> Residents under 65, Medicare coverage (or multiple types): 1.1% — 1,313th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 33.4% — 2,263rd highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 16.2% — 57th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.9% — 377th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
Source: BOB WESTON / iStock via Getty Images
7. Sebastian, Texas
> Residents under 65, no health insurance: 49.5%
> Residents under 65, Medicare coverage (or multiple types): 4.3% — 3,530th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 32.6% — 2,431st highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.7% — 3,913th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 15.4% — 48th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.0% — 421st lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: DenisTangneyJr / iStock via Getty Images
6. Citrus City, Texas
> Residents under 65, no health insurance: 51.2%
> Residents under 65, Medicare coverage (or multiple types): 3.6% — 4,617th highest of 11,039 towns (tied)
> Residents under 65, Medicaid coverage (or multiple types): 41.8% — 968th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 1.0% — 5,361st lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 6.6% — 2nd lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
Source: StellaMc / iStock via Getty Images
5. San Felipe Pueblo, New Mexico
> Residents under 65, no health insurance: 53.8%
> Residents under 65, Medicare coverage (or multiple types): 3.4% — 4,984th highest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 31.0% — 2,807th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 18.2% — 78th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 1.7% — 143rd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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Source: flissphil / Flickr
4. Fort Defiance, Arizona
> Residents under 65, no health insurance: 55.0%
> Residents under 65, Medicare coverage (or multiple types): 2.8% — 4,814th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 13.9% — 3,165th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.3% — 1,590th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 27.3% — 327th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.3% — 242nd lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.5% — 3,339th lowest of 11,039 towns
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Source: Vipersniper / iStock via Getty Images
3. Sand Point, Alaska
> Residents under 65, no health insurance: 55.4%
> Residents under 65, Medicare coverage (or multiple types): 0.9% — 1,108th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 14.6% — 3,368th lowest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.8% — 4,541st lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 25.9% — 265th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 3.6% — 631st lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.8% — 4,572nd lowest of 11,039 towns
Source: Loco Steve / Flickr
2. North Browning, Montana
> Residents under 65, no health insurance: 58.2%
> Residents under 65, Medicare coverage (or multiple types): 1.4% — 1,877th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 28.4% — 3,464th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.8% — 4,455th lowest of 11,039 towns
> Residents under 65, employer-based insurance (or multiple types): 11.2% — 18th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 2.0% — 189th lowest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
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1. Arivaca Junction, Arizona
> Residents under 65, no health insurance: 59.5%
> Residents under 65, Medicare coverage (or multiple types): 0.7% — 700th lowest of 11,039 towns
> Residents under 65, Medicaid coverage (or multiple types): 21.9% — 5,313th highest of 11,039 towns
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 1st lowest of 11,039 towns (tied)
> Residents under 65, employer-based insurance (or multiple types): 8.6% — 6th lowest of 11,039 towns
> Residents under 65, direct-purchase insurance (or multiple types): 9.3% — 4,921st highest of 11,039 towns
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 11,039 towns (tied)
Methodology
To determine the towns with the worst health insurance coverage in the nation, 24/7 Tempo 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 used census “place” geographies — a category that includes 29,573 incorporated legal entities and census-designated statistical entities. Of those, 29,320 had boundaries that fell within one of the 50 states or the District of Columbia.
We defined towns based on population thresholds — having at least 1,000 people and less than 25,000 people — and 13,332 of the places fell within these thresholds.
Towns were excluded if the noninstitutionalized civilian population under 65 was less than 1,000, or if the sampling error associated with a town’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 town’s under 65 uninsured rate was above 15% and greater than two standard deviations above the mean CV for all towns’ under 65 uninsured rates. We similarly excluded towns 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 doesn’t 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 U.S. Census Bureau.
The remaining 11,039 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 share 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.
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