Uninsured is the percentage of the population under age 65 that has no health insurance coverage. The Small Area Health Insurance Estimates uses the American Community Survey (ACS) definition of insured: Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans: Insurance through a current or former employer or union, insurance purchased directly from an insurance company, Medicare, Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability, TRICARE or other military health care, Indian Health Services, VA or any other type of health insurance or health coverage plan? Please note that the methods for calculating this measure changed in the 2012 Rankings.

Measure Tabs

Reason for Ranking

Lack of health insurance coverage is a significant barrier to accessing needed health care and to maintaining financial security.

The Kaiser Family Foundation released a report in December 2017 that outlines the effects insurance has on access to health care and financial independence. One key finding was that "Going without coverage can have serious health consequences for the uninsured because they receive less preventative care, and delayed care often results in serious illness or other health problems. Being uninsured can also have serious financial consequences, with many unable to pay their medical bills, resulting in medical debt."[1]

Measurement Strengths and Limitations

The multiple data inputs and modeling procedure that SAHIE uses allows for the estimation of uninsured rates for all U.S. counties and provides stable estimates. Health insurance status can change throughout the year for individuals depending on the employment environment, among other factors. Combining survey responses from multiple dates throughout the year gives a more representative account of the average health insurance status.

National household surveys are the standard method for health insurance estimates.[2] These estimates are not always consistent with each other, although SAHIE incorporates numerous household surveys to try to account for the variation.[3] Estimates of the uninsured population vary depending on survey design, implementation, data adjustment, and the definition of “uninsured”.[3]

Substantial changes in the rate of uninsurance have occured since the Affordable Care Act has take effect.