Approximately 83% of the U.S. population had some form of health insurance coverage in 2012, according to the latest data released jointly by Gallup and Healthways. While this was the first year of improvement since the group began the study, overall coverage remained lower than the 85% it was in 2008.

The level of health insurance coverage varies widely from city to city, according to the 2012 Gallup-Healthways Well-Being Index. In metropolitan areas such as Boston and Burlington, Vt., more than 95% of residents were covered. At the same time, barely half of the residents were insured in McAllen, Texas, the metro area with the lowest coverage. Based on the Gallup-Healthways Index, the 10 metropolitan statistical areas with the worst health insurance coverage are featured here.

Click here to see the cities with the worst health coverage

While the number has declined, a large segment of Americans with health insurance are still covered through their employers, at 44.5%. As a result, many of the metro areas with low health insurance coverage have high unemployment rates. At the end of 2012, seven of the 10 metro areas had among the highest unemployment rates in the country.

Jobs in areas like management, business, science, manufacturing and education tend to offer health coverage. These jobs also require higher education. Because residents in the cities without coverage have particularly low high school and college graduation rates, the cities have fewer residents working in sectors that offer benefits.

In some cases, it can be difficult to measure how poor coverage has affected the health of residents. For example, these metro areas have lower-than-average rates of cancer diagnosis. However, in an interview with 24/7 Wall St., Gallup’s research lead Dan Witters cautioned that it could be that the disease is not being detected because fewer people are getting regular check-ups.

For other measures of health, the expected effects of not being covered by insurance are clearer. Residents in these cities are more likely to have diabetes and hypertension, and to have had their health keep them from ordinary daily activities.

Generally, cities with large Hispanic populations had lower rates of the residents that are insured. In fact, the Hispanic population is the least likely of all other ethnic groups to be covered by health insurance, explained Witters. As an example, Witters cited McAllen, Texas, where roughly 90% of the area’s population are of Hispanic origin or descent. As mentioned, McAllen had the lowest health insurance coverage in the country last year.

The reasons for this is that places with large Hispanic populations tend to have “the newest documented citizens, and the highest percentage of undocumented citizens,” said Witters. These two groups are much less likely to have health insurance, either because they have not had time to establish themselves and obtain insurance, or because they are not legal residents.

To determine the 10 metro areas with the lowest health insurance coverage, 24/7 Wall St. reviewed figures from the Gallup-Healthways Well-Being Index for 2012. In addition to the percentage of residents with insurance coverage, we considered a variety of data from the Well-Being Index, including the percentage of residents with a personal doctor and the percentage of residents that report being able to afford health care. We also reviewed unemployment rates from the Bureau of Labor Statistics for December 2012, and occupation, poverty and educational attainment data from the U.S. Census Bureau for 2011, the most recent available data.

These are the cities with the worst health coverage.

10. Las Vegas-Paradise, Nev.
> Pct. insured: 73.6%
> Pct. with a doctor: 63.2% (5th lowest)
> Pct. with money for health care: 76.3% (12th lowest)
> Dec. 2012 unemployment: 10.0% (45th highest)

Just over 63% of the population of Las Vegas had a personal doctor, a lower percentage than all but four other metropolitan areas. The service industry employed 31% of the workforce, higher than all but one other metropolitan area in the country. In addition, 31% of the population worked in the arts and entertainment industry, also the second-highest percentage of all metro areas in the country. Workers in these industries are less likely to have health insurance than workers in other industries. For many of Las Vegas residents, money is incredibly tight. Just 75.9% of the population indicated they had enough money for food at all times in the past 12 months, while 85.8% said they had enough for shelter. Both percentages were among the 10 lowest of all metro areas in the country.

9. Houston-Sugar Land- Baytown, Texas
> Pct. insured: 73.4%
> Pct. with a doctor: 68.0% (12th lowest)
> Pct. with money for health care: 79.9% (61st lowest)
> Dec. 2012 unemployment: 6.0% (96th lowest)

Just over 60% of Houston area residents had a dentist appointment within the previous 12 months, well below the 67.5% of all Americans. Worse, just 68% of residents surveyed had a personal doctor, one of the lowest percentages in the nation. With an unemployment rate of 6% as of the end of last year, area residents were less likely than most Americans to be unemployed. However, they also were less likely than most Americans to have graduated high school. A high school diploma helps land a job that provides health insurance, and just 81.1% of adults 25 and over in the area had one, versus 85.9% nationally.

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8. Stockton, Calif.
> Pct. insured: 71.6%
> Pct. with a doctor: 66.6% (8th lowest)
> Pct. with money for health care: 81.1% (79th lowest)
> Dec. 2012 unemployment: 14.5% (9th highest)

Just 66.6% of the Stockton area population had a personal doctor, the eighth-lowest percentage of all metro areas and significantly lower than the 78.2% across the country. Since most people receive health insurance through their employers, the area’s high unemployment rate was likely a significant cause to the high percentage of uninsured residents. The unemployment rate in Stockton was 14.5% as of the end of 2012, among the highest rates in the country.

7. Salinas, Calif.
> Pct. insured: 71.4%
> Pct. with a doctor: 58.4% (2nd lowest)
> Pct. with money for health care: 77.8% (26th lowest)
> Dec. 2012 unemployment: 13.1% (15th highest)

Only 58.4% of people in Salinas had a personal doctor, lower than any other metro area in the country except for McAllen, Texas. Many occupations that provide benefits like health insurance may be difficult to obtain for the area’s residents due to the population’s low educational attainment. Just 68.9% of adults at least 25 years old had a high school diploma, among the lowest percentages across the country. Fortunately, Salinas residents are taking care of themselves better than people in many other metro areas by exercising and eating healthy. Nearly 60% of residents exercised 30 minutes a day at least three times in the previous week, and 63.4% ate at least five servings of fruit and vegetables four days in the prior week — among the highest percentages in the country.

6. Bakersfield, Calif.
> Pct. insured: 70.8%
> Pct. with a doctor: 59.3% (3rd lowest)
> Pct. with money for health care: 75.9% (11th lowest)
> Dec. 2012 unemployment: 13.5% (14th highest)

As of the end of 2012, Bakersfield had an unemployment rate of 13.5%, the 14th-highest rate in the country at that time. In addition to high unemployment, working residents tend to have jobs that are unlikely to provide health insurance coverage, such as agriculture, mining and forestry. Less than 25% of the population was employed in management, business and science occupations, in which people are more likely to be covered. Less than 60% of Bakersfield residents had a personal doctor, compared to 78.2% of Americans. Just 83.7% reported that it was easy for them to get medicine, nine percentage points lower than the national average.

5. Naples-Marco Island, Fla.
> Pct. insured:70.0%
> Pct. with a doctor: 68.2% (13th lowest)
> Pct. with money for health care: 78.4% (35th lowest)
> Dec. 2012 unemployment: 7.3% (183rd lowest)

Naples residents were among the most likely Americans to practice healthy behaviors, and the most likely in the nation to eat healthy. However, they also were among the least likely to have health insurance coverage, with only 70% of residents insured. Because of this, Naples residents were among the least likely Americans to have a personal doctor. In 2011, residents of Naples were less likely than those of most metro areas to work in professional, business and manufacturing occupations. These sectors are more likely to provide insurance than the service and sales occupations that make up more than half of all area jobs.

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4. Visalia-Porterville, Calif. 
> Pct. insured: 69.3%
> Pct. with a doctor: 64.1% (6th lowest)
> Pct. with money for health care: 75.2% (7th lowest)
> Dec. 2012 unemployment: 15.7% (6th highest)

The Visalia metro area is one of just four where fewer than 70% of residents had health insurance. In 2012, just over 64% of residents had a personal doctor, and barely three-quarters had enough money for medicine — all among the lowest rates in America. Visalia had one of the nation’s smallest concentrations of employees in management, business, science and arts occupations that tend to provide health insurance, at just 23% of all workers, versus 36% nationwide. A large proportion of workers lacked the skills to work in such occupations. That year, less than 70% of all adults age 25 and older had a college degree, among the lowest percentages in the nation.

3. El Paso, Texas
> Pct. insured: 67.9%
> Pct. with a doctor: 60.4% (4th lowest)
> Pct. with money for health care: 77.6% (23rd lowest)
> Dec. 2012 unemployment: 8.4% (109th highest)

Just 60.4% of El Paso residents indicated that they had a personal doctor, the fourth-lowest rate of all metro areas. The fact that many people do not have health insurance is problematic, given some widespread health problems in the area. Nearly 15% of the population has been diagnosed with diabetes, higher than all but just seven metropolitan areas in the country. Area residents also have a higher incidence of recurring knee or leg pain compared to the country as a whole. Almost a quarter of the population lived below the poverty level in 2011, making El Paso one of the most impoverished metropolitan areas in the country.

2. Yakima, Wash.
> Pct. insured: 67.1%
> Pct. with a doctor: 64.6% (7th lowest)
> Pct. with money for health care: 81.7% (94th lowest)
> Dec. 2012 unemployment: 11.2% (21st highest)

Yakima residents were twice as likely as Americans nationwide to work in a natural resources, construction or maintenance occupation as of 2011. That year, 18.2% of area workers were employed in such a job. In 2011, less than 72% of adult residents had a high school diploma, among the lowest rates in the nation. Without high-wage and benefit-providing jobs, barely two-thirds of residents surveyed by Gallup had health insurance in 2012. Obtaining medicine was, of course, also far more difficult for many residents — just 87% of area residents told Gallup that getting medicine was easy, among the lowest proportions in the nation. Compounding the problem, more than 31% of Yakima respondents were obese, versus less than 25% across the nation.

1. McAllen, Texas
> Pct. insured: 50.3%
> Pct. with a doctor: 53.4% (the lowest)
> Pct. with money for health care: 65.9% (the lowest)
> Dec. 2012 unemployment: 10.3% (35th highest)

Fewer McAllen residents had health insurance than any other metropolitan area in the country, with barely over half of the population insured. McAllen also had the lowest percentage of people with a personal doctor, at just 53.4% of the population. The poor coverage is especially problematic, given that the McAllen population is unhealthier than most. More than 21% of the population has been diagnosed with diabetes, while 38.5% were considered obese, both the highest percentages in the country. Poverty is a rampant problem in the McAllen area. In 2011, 37.7% of the population lived below the poverty level, the highest percentage of all metro areas.

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