Special Report
Cities With the Worst Health Insurance Coverage in the Nation
Published:
Nearly half of all Americans with health insurance receive coverage through their employer. When the COVID-19 pandemic hit, however, millions of Americans lost their jobs, and nearly 30% of U.S. residents lost their health insurance coverage. While many have returned to employment, the situation likely remains far from the pre-pandemic normal.
More than 1.2 million Americans so far have applied for coverage through the Affordable Care Act during a special enrollment period instituted by President Joe Biden. The period began in February.
It remains to be seen how much of an impact the pandemic has truly had on health coverage in the United States, notably in cities where a large share of Americans lack coverage. As many as 10.3% of Americans did not have health insurance coverage in 2019, the most recent year for which data was available. In a number of American cities, the share was two or even three times higher.
To determine the cities 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.
The 50 cities on this list can be found in just seven states, 35 of which are in either Texas or Florida alone.
Click here to see the cities with the worst health insurance coverage in the nation.
Click here to see our methodology.
50. Miami, Florida
> Adults under 65, no health insurance: 23.2%
> Adults under 65, Medicare coverage (or multiple types): 3.2% — 503rd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 23.6% — 622nd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.5% — 243rd lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 34.5% — 48th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 19.1% — 62nd highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.3% — 158th lowest of 1,669 cities
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49. Lufkin, Texas
> Adults under 65, no health insurance: 23.2%
> Adults under 65, Medicare coverage (or multiple types): 3.3% — 436th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 25.9% — 512th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.6% — 390th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 44.8% — 218th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.0% — 463rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.6% — 446th lowest of 1,669 cities
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48. Sarasota, Florida
> Adults under 65, no health insurance: 23.3%
> Adults under 65, Medicare coverage (or multiple types): 3.7% — 346th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 19.4% — 819th lowest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.5% — 427th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 41.5% — 135th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 15.8% — 153rd highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.8% — 485th highest of 1,669 cities
47. Conroe, Texas
> Adults under 65, no health insurance: 23.3%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 566th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 13.7% — 479th lowest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.2% — 660th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 55.1% — 599th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 9.8% — 831st highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.3% — 696th highest of 1,669 cities
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46. Harlingen, Texas
> Adults under 65, no health insurance: 23.4%
> Adults under 65, Medicare coverage (or multiple types): 3.0% — 547th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 30.4% — 342nd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.0% — 811th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 39.2% — 98th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.1% — 481st lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.7% — 486th lowest of 1,669 cities
45. Long Branch, New Jersey
> Adults under 65, no health insurance: 23.5%
> Adults under 65, Medicare coverage (or multiple types): 2.7% — 669th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 28.1% — 422nd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.1% — 23rd lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 40.1% — 115th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 10.3% — 737th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 348th lowest of 1,669 cities
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44. Marumsco, Virginia
> Adults under 65, no health insurance: 23.5%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 547th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 14.6% — 535th lowest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.9% — 246th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 52.6% — 495th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.6% — 587th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 4.0% — 190th highest of 1,669 cities
43. Myrtle Beach, South Carolina
> Adults under 65, no health insurance: 23.5%
> Adults under 65, Medicare coverage (or multiple types): 3.6% — 351st highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 26.0% — 503rd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.2% — 642nd highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 34.4% — 45th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 13.8% — 255th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 2.4% — 329th highest of 1,669 cities
42. Egypt Lake-Leto, Florida
> Adults under 65, no health insurance: 23.7%
> Adults under 65, Medicare coverage (or multiple types): 3.2% — 495th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 25.3% — 533rd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.1% — 761st highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 38.1% — 83rd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 12.9% — 327th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.5% — 619th highest of 1,669 cities
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41. Fort Pierce, Florida
> Adults under 65, no health insurance: 23.7%
> Adults under 65, Medicare coverage (or multiple types): 4.5% — 184th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 33.9% — 234th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.3% — 579th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 32.6% — 33rd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 9.9% — 795th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.3% — 175th lowest of 1,669 cities
40. Lawrenceville, Georgia
> Adults under 65, no health insurance: 23.7%
> Adults under 65, Medicare coverage (or multiple types): 2.0% — 642nd lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 25.9% — 513th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 583rd lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 43.5% — 190th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.0% — 453rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.7% — 526th lowest of 1,669 cities
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39. Weslaco, Texas
> Adults under 65, no health insurance: 23.8%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 546th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 29.0% — 391st highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.0% — 809th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 42.1% — 146th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.6% — 100th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.0% — 778th lowest of 1,669 cities
38. South Miami Heights, Florida
> Adults under 65, no health insurance: 24.1%
> Adults under 65, Medicare coverage (or multiple types): 2.8% — 630th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 28.3% — 418th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 184th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 33.9% — 43rd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 13.4% — 277th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 55th lowest of 1,669 cities
37. University (Hillsborough County), Florida
> Adults under 65, no health insurance: 24.1%
> Adults under 65, Medicare coverage (or multiple types): 2.9% — 603rd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 28.6% — 407th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.7% — 315th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 38.2% — 85th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 10.2% — 753rd highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.5% — 620th highest of 1,669 cities
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36. West New York, New Jersey
> Adults under 65, no health insurance: 24.1%
> Adults under 65, Medicare coverage (or multiple types): 1.6% — 427th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 28.8% — 400th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 134th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 42.5% — 166th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 7.5% — 346th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 106th lowest of 1,669 cities
35. Homestead, Florida
> Adults under 65, no health insurance: 24.2%
> Adults under 65, Medicare coverage (or multiple types): 2.2% — 751st lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 33.8% — 236th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.3% — 565th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 33.9% — 42nd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.0% — 450th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 2.4% — 333rd highest of 1,669 cities
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34. Baytown, Texas
> Adults under 65, no health insurance: 24.4%
> Adults under 65, Medicare coverage (or multiple types): 2.8% — 639th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 20.1% — 815th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 686th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 49.1% — 350th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 6.1% — 141st lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.0% — 743rd lowest of 1,669 cities
33. North Miami Beach, Florida
> Adults under 65, no health insurance: 24.6%
> Adults under 65, Medicare coverage (or multiple types): 2.6% — 717th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 25.2% — 539th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 612th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 35.2% — 51st lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 16.0% — 140th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 361st lowest of 1,669 cities
32. Greenacres, Florida
> Adults under 65, no health insurance: 24.7%
> Adults under 65, Medicare coverage (or multiple types): 2.5% — 750th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 24.2% — 592nd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.6% — 378th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 41.6% — 137th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 13.2% — 302nd highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.4% — 213th lowest of 1,669 cities
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31. Edinburg, Texas
> Adults under 65, no health insurance: 25.0%
> Adults under 65, Medicare coverage (or multiple types): 1.5% — 336th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 21.7% — 719th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.2% — 685th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 45.7% — 255th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 9.3% — 743rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.0% — 768th lowest of 1,669 cities
30. Passaic, New Jersey
> Adults under 65, no health insurance: 25.1%
> Adults under 65, Medicare coverage (or multiple types): 3.6% — 359th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 41.4% — 95th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.2% — 40th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 28.4% — 10th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.4% — 80th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.1% — 26th lowest of 1,669 cities
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29. Pompano Beach, Florida
> Adults under 65, no health insurance: 25.1%
> Adults under 65, Medicare coverage (or multiple types): 2.8% — 663rd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 23.2% — 640th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 596th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 36.8% — 70th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 15.9% — 147th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.9% — 723rd lowest of 1,669 cities
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28. Hallandale Beach, Florida
> Adults under 65, no health insurance: 25.2%
> Adults under 65, Medicare coverage (or multiple types): 2.8% — 622nd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 21.6% — 726th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 628th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 37.6% — 76th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 16.5% — 121st highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.8% — 597th lowest of 1,669 cities
27. Hialeah, Florida
> Adults under 65, no health insurance: 25.3%
> Adults under 65, Medicare coverage (or multiple types): 2.8% — 636th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 26.7% — 478th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.2% — 56th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 29.5% — 14th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 19.0% — 66th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.3% — 120th lowest of 1,669 cities
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26. Houston, Texas
> Adults under 65, no health insurance: 25.4%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 576th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 22.1% — 704th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.7% — 571st lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 45.5% — 245th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.5% — 578th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 362nd lowest of 1,669 cities
25. Chillum, Maryland
> Adults under 65, no health insurance: 25.8%
> Adults under 65, Medicare coverage (or multiple types): 1.7% — 463rd lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 27.8% — 434th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 649th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 40.0% — 113th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 7.5% — 361st lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 347th lowest of 1,669 cities
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24. Union City, New Jersey
> Adults under 65, no health insurance: 25.8%
> Adults under 65, Medicare coverage (or multiple types): 1.5% — 326th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 32.9% — 263rd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 133rd lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 36.2% — 62nd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 6.5% — 188th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 61st lowest of 1,669 cities
23. Dallas, Texas
> Adults under 65, no health insurance: 26.0%
> Adults under 65, Medicare coverage (or multiple types): 2.7% — 679th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 21.1% — 758th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.7% — 519th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 45.0% — 224th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.1% — 494th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 344th lowest of 1,669 cities
22. Garland, Texas
> Adults under 65, no health insurance: 26.1%
> Adults under 65, Medicare coverage (or multiple types): 1.7% — 437th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 19.7% — 831st highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.7% — 464th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 45.6% — 249th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 10.1% — 765th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.6% — 399th lowest of 1,669 cities
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21. Mission Bend, Texas
> Adults under 65, no health insurance: 26.4%
> Adults under 65, Medicare coverage (or multiple types): 2.0% — 615th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 18.4% — 763rd lowest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.6% — 379th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 46.4% — 274th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 9.9% — 791st highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.3% — 138th lowest of 1,669 cities
20. Haltom City, Texas
> Adults under 65, no health insurance: 26.7%
> Adults under 65, Medicare coverage (or multiple types): 2.0% — 658th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 21.6% — 725th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 675th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 46.2% — 272nd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.9% — 125th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.9% — 740th lowest of 1,669 cities
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19. McAllen, Texas
> Adults under 65, no health insurance: 28.4%
> Adults under 65, Medicare coverage (or multiple types): 2.2% — 738th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 21.7% — 718th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 598th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 37.3% — 73rd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 14.2% — 227th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.7% — 559th lowest of 1,669 cities
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18. Pasadena, Texas
> Adults under 65, no health insurance: 28.8%
> Adults under 65, Medicare coverage (or multiple types): 1.8% — 540th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 24.3% — 587th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.7% — 562nd lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 41.4% — 130th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.6% — 98th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 349th lowest of 1,669 cities
17. Plainfield, New Jersey
> Adults under 65, no health insurance: 28.8%
> Adults under 65, Medicare coverage (or multiple types): 2.6% — 729th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 28.8% — 401st highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.6% — 398th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 38.0% — 82nd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.8% — 123rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.6% — 419th lowest of 1,669 cities
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16. North Miami, Florida
> Adults under 65, no health insurance: 28.9%
> Adults under 65, Medicare coverage (or multiple types): 2.1% — 672nd lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 24.7% — 566th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 205th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 34.6% — 49th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 13.0% — 320th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.3% — 125th lowest of 1,669 cities
15. Channelview, Texas
> Adults under 65, no health insurance: 30.0%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 578th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 19.9% — 823rd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 187th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 45.9% — 265th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 6.0% — 133rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 49th lowest of 1,669 cities
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14. Laredo, Texas
> Adults under 65, no health insurance: 30.0%
> Adults under 65, Medicare coverage (or multiple types): 1.7% — 452nd lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 26.8% — 474th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.6% — 364th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 36.8% — 68th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.5% — 568th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.4% — 244th lowest of 1,669 cities
13. Chamblee, Georgia
> Adults under 65, no health insurance: 30.0%
> Adults under 65, Medicare coverage (or multiple types): 1.3% — 230th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 16.8% — 661st lowest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 188th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 44.3% — 208th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 9.3% — 754th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.7% — 521st lowest of 1,669 cities
12. Mission, Texas
> Adults under 65, no health insurance: 31.0%
> Adults under 65, Medicare coverage (or multiple types): 2.3% — 778th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 24.1% — 597th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.5% — 280th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 29.2% — 12th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 16.2% — 132nd highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.6% — 456th lowest of 1,669 cities
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11. Eagle Pass, Texas
> Adults under 65, no health insurance: 31.3%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 554th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 24.8% — 562nd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.3% — 80th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 37.3% — 74th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.7% — 612th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 46th lowest of 1,669 cities
10. Cloverleaf, Texas
> Adults under 65, no health insurance: 31.5%
> Adults under 65, Medicare coverage (or multiple types): 2.4% — 815th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 31.2% — 304th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.5% — 249th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 31.4% — 23rd lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.0% — 48th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 67th lowest of 1,669 cities
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9. Socorro, Texas
> Adults under 65, no health insurance: 32.5%
> Adults under 65, Medicare coverage (or multiple types): 2.8% — 656th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 28.0% — 427th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.9% — 705th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 31.9% — 26th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 8.8% — 635th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.8% — 606th lowest of 1,669 cities
8. Port Arthur, Texas
> Adults under 65, no health insurance: 32.9%
> Adults under 65, Medicare coverage (or multiple types): 3.1% — 509th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 27.2% — 464th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 592nd lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 31.9% — 24th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 7.6% — 373rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.7% — 550th lowest of 1,669 cities
7. Balch Springs, Texas
> Adults under 65, no health insurance: 34.1%
> Adults under 65, Medicare coverage (or multiple types): 2.5% — 798th highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 27.0% — 467th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 586th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 33.7% — 40th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.5% — 90th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.1% — 38th lowest of 1,669 cities
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6. West Odessa, Texas
> Adults under 65, no health insurance: 34.3%
> Adults under 65, Medicare coverage (or multiple types): 2.1% — 669th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 12.6% — 428th lowest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.8% — 680th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 47.9% — 317th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 5.1% — 53rd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.1% — 39th lowest of 1,669 cities
5. Brownsville, Texas
> Adults under 65, no health insurance: 34.6%
> Adults under 65, Medicare coverage (or multiple types): 2.6% — 732nd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 27.4% — 455th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.7% — 449th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 32.0% — 28th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 6.1% — 142nd lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 1.0% — 761st lowest of 1,669 cities
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4. Pharr, Texas
> Adults under 65, no health insurance: 34.8%
> Adults under 65, Medicare coverage (or multiple types): 3.1% — 532nd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 31.4% — 301st highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.7% — 450th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 27.4% — 6th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 6.5% — 186th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.4% — 243rd lowest of 1,669 cities
3. San Juan, Texas
> Adults under 65, no health insurance: 37.2%
> Adults under 65, Medicare coverage (or multiple types): 4.3% — 223rd highest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 23.9% — 603rd highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 1.3% — 585th highest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 30.3% — 18th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 6.3% — 164th lowest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.8% — 651st lowest of 1,669 cities
2. Lake Worth, Florida
> Adults under 65, no health insurance: 37.5%
> Adults under 65, Medicare coverage (or multiple types): 2.3% — 780th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 25.0% — 548th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.9% — 758th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 27.7% — 7th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 10.1% — 764th highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.5% — 322nd lowest of 1,669 cities
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1. Golden Gate, Florida
> Adults under 65, no health insurance: 38.3%
> Adults under 65, Medicare coverage (or multiple types): 1.9% — 599th lowest of 1,669 cities
> Adults under 65, Medicaid coverage (or multiple types): 23.4% — 627th highest of 1,669 cities
> Adults under 65, VA coverage (or multiple types): 0.4% — 156th lowest of 1,669 cities
> Adults under 65, employer-based insurance (or multiple types): 27.8% — 8th lowest of 1,669 cities
> Adults under 65, direct-purchase insurance (or multiple types): 10.9% — 601st highest of 1,669 cities
> Adults under 65, Tricare/military insurance (or many types): 0.2% — 86th lowest of 1,669 cities
Methodology:
To determine the cities 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.
We used census “place” geographies — a category that includes 29,573 incorporated legal entities and Census-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.
The sampling error was defined as too high 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 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, those covered by more than one type of insurance are included in each group.
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