What factors influence uninsured rates?

About 9% of Americans were uninsured in 2020 – an increase of about one percentage point from 2019. 

According to the Census Bureau, an individual is considered uninsured if they do not have a qualifying health care plan^[1] for at least some portion of the year. While the uninsured rate is down from its peak of 16.3% in 2010, there are still segments of the population with lower rates of insurance coverage than the national total.

Demographic factors such as age, income, and education impact whether someone has health insurance and what kind of coverage they might have, according to data from the 2020 Current Population Survey.

Which states have the highest rate of uninsured people?

On a state-by-state basis, the uninsured rate for the nonelderly population^[2] ranged from 20.4% in Texas to 3.2% in Massachusetts as of 2020, the most recently available data shows.

One explanation for the wide range of uninsured between states is whether a state expanded Medicaid through the Affordable Care Act (ACA). The five states with the highest uninsured rates, Texas, Oklahoma, Georgia, Florida, and Mississippi, have not expanded Medicaid through ACA.

The five states with the lowest uninsured rates, Massachusetts, Rhode Island, Hawaii, Vermont, and Connecticut, have all expanded access to Medicaid.

Three of these five states, Massachusetts, Rhode Island, and Vermont, have individual mandates in place that require all individuals to have health insurance coverage or pay a fine^[3]. A similar provision was included in the ACA but the fine was reduced to zero as part of the 2017 Tax Cuts and Jobs Act.

Do uninsured rates vary across racial and ethnic groups?

The percentage of Americans with health insurance varies by race and ethnicity. Asian Americans experienced the lowest uninsured rate in 2020, at 5.9%. Hispanic Americans were uninsured at three times that rate — 18.3% — the highest of any racial or ethnic group.

Most Americans get health insurance through their employers. About 41% of the Hispanic population gets insurance through work, the lowest of any race or ethnicity group.

The uninsured rate increased for Hispanic, Black, and white Americans between 2019 and 2020, but decreased slightly for Asian individuals.

Do uninsured rates vary by age?

Nearly all people over 65 years of age were insured in 2020. Adults 65 years of age and older qualify for Medicare, a subsidized governmental insurance program. The program is the main reason why the age group has the lowest uninsured rate in the US.

Americans 19 to 25 years old have the highest uninsured rates of any age group. Adults up to the age of 25 can still be claimed as dependents by their parents, and as such can be covered by their parents’ health insurance. However, 14.4% of adults aged 19 to 25 years old were uninsured in 2020.

Children under the age of 18 from families that do not qualify for Medicaid but still struggle to pay for health insurance may qualify for the Children’s Health Insurance Program (CHIP.) This helps explain why the uninsured rate for children under 18 years of age is eight percentage points lower than the 19 to 25 age group.

Does income influence if a person has health insurance?

The uninsured rate generally decreased as household income increased, according to Census data. About 2.8% of households with an income of at least $150,000 lacked health insurance. Households with income less than $25,000 in 2020 had an uninsured rate of 14.4%.

Higher paying jobs may be more likely to provide employment-based insurance, which is how most Americans get their insurance. They are also more likely to be able to afford insurance on their own.

Individuals meeting federal poverty levels may qualify for Medicaid, a government-sponsored healthcare program through the states that provides subsidized or free insurance.

Do uninsured rates vary by education level?

The Americans with the highest levels of education have the lowest uninsured rates as of 2020.

About 3.5% of people with a graduate degree were uninsured. Nearly one in three individuals who did not complete high school did not have qualifying health insurance.

The uninsured rate for those with a high school diploma is 15.8 percentage points lower than for people who didn’t graduate high school.

For more on healthcare, read USAFacts’ breakdown of the different types of health insurance and get the facts every week by signing up for our newsletter.