Special Report

Counties Where the Most People Don't Have Health Insurance


To determine the counties with the worst health insurance coverage in the nation, 24/7 Tempo reviewed five-year estimates of the percentage of the noninstitutionalized civilian population between the ages of 19 and 65 without health insurance from the U.S. Census Bureau’s 2020 American Community Survey. 

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 15% or greater.

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. 

The shares of the population covered by VA, employer, and direct-purchase insurance 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. When a person is covered by more than one type of insurance, that is, they are included in each group.

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