States With the Highest and Lowest Uninsured Rates

As discussions about the future of the Affordable Care Act (ACA) continue on Capitol Hill, at least one thing is certain: The law has led to a record number of people having health insurance.

According to data released this week from the U.S. Census Bureau, only 8.8 percent of Americans were uninsured in 2016. That's down from 13.3 percent in 2013, the year before much of the ACA took effect. Since then, every single state has seen their uninsured rate drop.

It appears increasingly unlikely that the ACA, President Obama's signature health-care law, will be repealed by the year’s end, but there’s continued uncertainty about premiums and insurer options for the coming year. Meanwhile, the Trump administration has shortened this year's open enrollment period and slashed millions of dollars in federal funding that went to advertising and organizations that help people enroll in Obamacare.

Advocates worry all of the uncertainty and changes will confuse consumers and hurt their ability to sign up for health insurance. Some states, however, are extending their open enrollment period beyond the new federal deadline. 

As for the uninsured statistics, there was little change in the state rankings from last year. The states that had the highest and lowest rates of uninsured largely kept their places, although the percentages all dipped a bit.

As in the past, the states with the lowest rates of uninsured all expanded Medicaid -- one of the central and most controversial parts of the ACA -- and the states with the highest rates of uninsured all chose not to expand Medicaid.

Here's the breakdown:

HIGHEST

Texas

Rate of uninsured: 16.6 percent

The state's uninsured rate is the highest in the country and double the national average. But it’s still a big improvement from the years before the ACA became law. At that time, nearly a quarter of Texans lacked health insurance. 

The Lone Star State has always had historically high numbers of uninsured, partially attributed to a large immigrant population, a limited Medicaid program and a lower-than-average rate of employers who offer health coverage. 

Neither Gov. Greg Abbott nor the legislature have considered expanding Medicaid.

Oklahoma

Rate of uninsured: 13.8 percent

Oklahoma has the second-highest rate of uninsured -- barely budging from it’s 13.9 percent rate last year. 

The state's premiums rose 76 percent last year, which was one of the biggest jumps in the country. Although most people who take advantage of the ACA pay little to nothing in premiums, the large increase might have discouraged some from shopping on the marketplace at all.

Republican Gov. Mary Fallin doesn’t support Medicaid expansion, and the issue hasn’t been revisited by the state legislature since a bill died last year. 

Georgia

Rate of uninsured: 12.9 percent

Georgia hasn’t moved from its position as the state with the third-highest uninsured rate. The state has a strict Medicaid program, only allowing parents with incomes of 40 percent below the poverty line to qualify.

Like all of the other states with the highest uninsured rates, Georgia didn't expand Medicaid. In fact, GOP Gov. Nathan Deal signed a bill that made it illegal for state employees to even advocate publicly for Medicaid expansion.

But his tune might be changing.

After Congress failed to repeal the ACA this summer, Deal said his cabinet was “exploring” new health-care options.

Florida

Rate of uninsured: 12.5 percent

Like Texas, Florida can partially attribute its higher-than-average uninsured rate to a large immigrant population and a strict Medicaid program.

In Florida, families with incomes between 133 and 200 percent of the federal poverty line have to pay a premium -- something other states don’t require. Florida historically has also had a large number of uninsured children, which dipped to 6.6 percent, down from around 9 percent last year.

The state Senate passed a bill in 2015 to expand Medicaid, but Republican Gov. Rick Scott rejected it.

Mississippi

Rate of uninsured: 11.8 percent

Mississippi’s appearance on this list is unsurprising. Not only did it not expand Medicaid, a December 2016 study from the Commonwealth Fund ranked the state 49th in health-care access and affordability.

But Medicaid expansion is unlikely to happen: Both GOP Gov. Phil Bryant and the state legislature have rejected the idea. 

LOWEST

Massachusetts

Rate of uninsured: 2.5 percent

Massachusetts’ 2006 universal health-care law served as the roadmap for the ACA, and the state has had a record low number of uninsured ever since. The number keeps falling, however, because the state expanded Medicaid further under the ACA and has its lowest unemployment rate in 15 years.

Vermont

Rate of uninsured: 3.7 percent

In addition to expanding Medicaid, Vermont has been tinkering with its health-care system for years, trying to get the number of uninsured as close to zero as possible. The state also has low unemployment and a generous safety net, with robust Medicaid offerings and preventative health programs.

Hawaii

Rate of uninsured: 3.5 percent

Hawaii is staying put for the second year in a row as the state with the third-lowest uninsured rate. Medicaid expansion had a huge hand in this: About half of those previously uninsured became covered under the law. 

But even before the ACA -- since 1976 actually -- the state has mandated that employers offer insurance benefits to employees who work 20 or more hours a week. The ACA only requires it for 30 or more hours a week. 

Minnesota

Rate of uninsured: 4.1 percent

The state’s Medicaid program has always been more generous than most states for the working poor, and the state expanded Medicaid under the ACA immediately. 

State officials also took steps last year to make premiums more affordable after they jumped by 60 percent. Lawmakers passed a bill that offered anyone who didn’t qualify for subsides a 25 percent discount on their plans, likely keeping people who would have dropped their plan otherwise.