Uninsured rates of Americans under the age of 65 decreased significantly from 2013 (the year before many provisions of the ACA took effect) to 2020. During that span, uninsured rates dropped in 2,823 counties and rose in just five counties. Likewise, 1,068 (34%) U.S. counties had an estimated uninsured rate below 10% in 2020, up from 33.6% of counties in 2019 and 4.1% in 2013.

Other SAHIE highlights:

• Estimated county uninsured rates ranged from 2.3% to 41.4%, with a median county uninsured rate of 10.7%.
• The Northeast and Midwest had the nation’s largest share of counties with low (below 10.0%) uninsured rates, and the South had the largest share with high (above 15.0%) uninsured rates.
• County uninsured rates of working-age adults (18 to 64) living at or below 138% of the poverty level ranged from 3.7% to 72.7%. The median county uninsured rate among this population was 21.3%.
• In states that expanded Medicaid eligibility, 10.3% of counties (187 of 1,814) had an estimated uninsured rate above 20% among working-age adults living at or below 138% of poverty, compared to 82.5% of counties (1,096 of 1,328) in states that didn’t expand Medicaid eligibility.
• State uninsured rates varied by race and ethnicity. Non-Hispanic White populations had lower estimated uninsured rates than both Hispanic and non-Hispanic Black populations under the age of 65 in every state and the District of Columbia. Hispanic populations had higher estimated uninsured rates than both non-Hispanic White and Black populations under the age of 65 in every state and the District of Columbia.

For more information, visit our interactive data and mapping tool on our website at <www.census.gov/data-tools/demo/sahie>. This tool allows users to create and download state and county custom tables, thematic maps and time-trend charts for all concepts available annually from 2006 to 2020.

No news release with this report. Tip sheet only.

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