Health and Healthcare

This City Has the Worst Health Insurance in America

Douglas A. McIntyre

Published: July 9, 2021 8:05 am

Health insurance is among the most prized services to which Americans have access. In general, the United States is not a healthy country. Bad habits that range from smoking to overeating trigger heart disease, Type 2 diabetes and lung disease. The cost to care for Americans in the final year of their lives can be extraordinary. This stands in sharp contrast to much lower health care costs in other developed countries.

One solution that health care experts and doctors sometimes propose is universal health care, a system that has brought down costs in nations such as Canada and the United Kingdom. The United States continues to cling to a system in which many people pay high prices for doctor visits, medical procedures and hospital stays.

To determine the city with the worst health insurance coverage in the nation, 24/7 Wall St. reviewed five-year estimates of the percentage of the noninstitutionalized civilian population under 65 without health insurance from the U.S. Census Bureau’s 2019 American Community Survey (ACS).

The 50 cities on the finalist list can be found in just seven states. The list included “place” geographies, a category that includes 29,573 incorporated legal entities and Census Bureau-designated statistical entities. Of those, 29,320 had boundaries that fell within one of the 50 states or the District of Columbia.

We defined cities based on a population threshold (having more than 25,000 people), and 1,775 of the places fell within this threshold.

Cities were excluded if the sampling error associated with a city’s data was deemed too high. That is, if the coefficient of variation (a statistical assessment of how reliable an estimate is) for a city’s under 65 uninsured rate was above 15% and greater than two standard deviations above the mean CV for all cities’ under 65 uninsured rates. We similarly excluded cities that had a sampling error too high for their under 65 noninstitutionalized civilian population, using the same definition.

We selected the under 65 age group because Americans become eligible for Medicare at age 65, and the uninsured rate for the population 65 and older is less than 1% nationwide. However, because the Census Bureau does not publish insurance coverage estimates specifically for the under 65 age group, we aggregated the data from more granular age breakdowns.

To ensure each aggregate estimate’s sampling error could be assessed using the definition above, we derived a margin of error for each aggregate estimate using the successive differences replication variance estimation methodology recommended and used by the U.S. Census Bureau.

A total of 1,669 places remained and were ranked based on their under 65 uninsured rates. To break ties, we used the number of insured people in the same population group.

The share of the population covered by each type of insurance (Medicare, Medicaid, Veterans Administration, employer, direct-purchase and Tricare/military) are for the same cohort and are also aggregated from five-year ACS estimates. The estimates reflect people who are covered by that type of insurance alone or in combination with other types on the list. So, some people covered by more than one type of insurance are included in each group.

The American city with the worst health insurance is Golden Gate, Florida. Here are the details:

• No health insurance: 38.3%
• Medicare coverage: 1.9% (599th lowest of the 1,669 cities)
• Medicaid coverage: 23.4% (627th highest)
• VA coverage: 0.4% (156th lowest)
• Employer-based insurance: 27.8% (eighth lowest)
• Direct-purchase insurance: 10.9% (601st highest)
• Tricare/military insurance: 0.2% (86th lowest)

Click here to read see which American cities have the worst health care.