Guide Rankings Health Updated May 31, 2026

Uninsured Rate by State

Large hospital building with a main entrance and surrounding road

Uninsured Rate by State

Ranking - Health

Quick Answer

Uninsured Rate by State

  1. 1

    Texas has the highest uninsured rate at 16.4%, a position it has held for years by not expanding Medicaid. Low-income adults earn too little for ACA marketplace subsidies but too much for traditional Medicaid, leaving them uninsured.

  2. 2

    Massachusetts (2.6%) has the lowest uninsured rate, with Hawaii (3.2%) close behind. Massachusetts has had near-universal coverage since enacting its own health reform law in 2006 — the model for the ACA. Hawaii has a long-standing employer mandate that predates the ACA.

  3. 3

    The national uninsured rate is approximately 8% as of 2023, down significantly from 16% in 2010. States that expanded Medicaid have consistently lower uninsured rates than non-expansion states.

Map

Uninsured Rate by State 2026 Map

Uninsured %
No data
Uninsured Rate by State 2026 Map
Rank State Uninsured %
1 Texas 16.4
2 Georgia 11.4
3 Oklahoma 11.4
4 Nevada 10.8
5 Florida 10.7
6 Wyoming 10.7
7 Alaska 10.4
8 Mississippi 10.3
9 Arizona 9.9
10 Tennessee 9.3
11 North Carolina 9.2
12 New Mexico 9.1
13 South Carolina 9.1
14 Arkansas 8.9
15 Idaho 8.9
16 Alabama 8.5
17 Kansas 8.4
18 Montana 8.4
19 South Dakota 8.3
20 Utah 8
21 Missouri 7.5
22 New Jersey 7.2
23 Indiana 6.9
24 Louisiana 6.9
25 Colorado 6.7
26 Delaware 6.5
27 California 6.4
28 Virginia 6.4
29 Maryland 6.3
30 Washington 6.3
31 Illinois 6.2
32 Nebraska 6.1
33 Ohio 6.1
34 Maine 5.9
35 West Virginia 5.9
36 Connecticut 5.7
37 Oregon 5.5
38 Kentucky 5.4
39 Pennsylvania 5.4
40 Iowa 5
41 Wisconsin 4.9
42 New York 4.8
43 New Hampshire 4.7
44 Michigan 4.5
45 North Dakota 4.5
46 Rhode Island 4.5
47 Minnesota 4.2
48 Vermont 3.4
49 Hawaii 3.2
50 Massachusetts 2.6

Texas stands alone at the top. The South and Southwest show the deepest red. Massachusetts and Hawaii are near-white -- both have near-universal coverage through state-level insurance mandates.

Uninsured Rate by State Table

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Print-ready table — Uninsured Rate by State

States with the Highest and Lowest Uninsured Rates

Highest

16.4
Texas flag
Texas #1

Lowest

2.6
Massachusetts flag
Massachusetts #50

Top 10 Highest — Uninsured Rate (%)

#1 Texas flag Texas
16.4
#2 Georgia flag Georgia
11.4
#3 Oklahoma flag Oklahoma
11.4
#4 Nevada flag Nevada
10.8
#5 Florida flag Florida
10.7
#6 Wyoming flag Wyoming
10.7
#7 Alaska flag Alaska
10.4
#8 Mississippi flag Mississippi
10.3
#9 Arizona flag Arizona
9.9
#10 Tennessee flag Tennessee
9.3

Top 10 Lowest — Uninsured Rate (%)

#50 Massachusetts flag Massachusetts
2.6
#49 Hawaii flag Hawaii
3.2
#48 Vermont flag Vermont
3.4
#47 Minnesota flag Minnesota
4.2
#46 Rhode Island flag Rhode Island
4.5
#45 North Dakota flag North Dakota
4.5
#44 Michigan flag Michigan
4.5
#43 New Hampshire flag New Hampshire
4.7
#42 New York flag New York
4.8
#41 Wisconsin flag Wisconsin
4.9

Why Massachusetts Has Near-Universal Health Coverage

Hospital campus with multiple buildings and a front entrance
Broad coverage systems depend on provider networks, enrollment infrastructure, and hospitals able to absorb large insured populations.

Massachusetts' 2.6% uninsured rate is the product of the 2006 Massachusetts Health Care Reform Act, commonly called RomneyCare, which required all residents to obtain health insurance or pay a tax penalty and established a state exchange for subsidized coverage. The law predated the Affordable Care Act by four years and served as its template. Continuous enforcement since 2006 has built a near-universal coverage infrastructure.

Massachusetts also has robust Medicaid coverage under MassHealth, which covers adults with incomes up to 133% of the federal poverty line. The state's high median household income means fewer residents fall into income gaps where subsidies don't apply. Hawaii (3.2%) follows through a different mechanism: the state has required employers to offer health insurance since the Hawaii Prepaid Health Care Act of 1974, the oldest employer mandate in the country.

Why Texas Has the Highest Uninsured Rate

Large urban medical complex beside busy roads and parking areas
High-population states can have major hospital systems and still leave large numbers of residents outside formal coverage.

Texas' 16.4% uninsured rate, more than six times Massachusetts' rate, is driven primarily by the state's decision not to expand Medicaid under the Affordable Care Act. Texas is one of a small number of remaining states without full expansion, leaving adults with incomes between 0% and 100% of the federal poverty line in a coverage gap: they earn too little for ACA marketplace subsidies but don't qualify for traditional Medicaid.

Texas also has a large population of low-wage workers in agriculture, construction, and hospitality, sectors with low rates of employer-sponsored insurance. With roughly 5 million uninsured residents, Texas accounts for about 20% of all uninsured Americans, despite representing only 9% of the U.S. population.

Medicaid Expansion Is the Single Biggest Policy Variable

The ACA's Medicaid expansion, made available to states in 2014, extended coverage to adults with incomes up to 138% of the federal poverty line. States that adopted expansion generally saw uninsured rates fall by 30% to 50% over the following five years. States that did not expand, including Texas, Florida, Georgia, and several Southern states, kept uninsured rates significantly higher.

The staggered adoption creates a visible policy experiment in the data: states that expanded earlier consistently outperform states that expanded later or not at all. Michigan (4.5%), which expanded Medicaid in 2014, now has one of the lowest uninsured rates of any non-coastal state despite being a Rust Belt economy with average household income near the national median.

The Coverage Gap in Non-Expansion States

In states that have not fully expanded Medicaid, adults with incomes below 100% of the federal poverty line fall into a coverage gap. They earn too little to qualify for ACA marketplace subsidies (which start at 100% of poverty) but too much for traditional Medicaid in those states. An estimated 1.5 to 2 million Americans remain in this gap as of 2024.

The coverage gap is concentrated in the South. Texas, Florida, Georgia, Alabama, Mississippi, Tennessee, South Carolina, and Kansas all have had significant coverage-gap populations in recent years. The gap disproportionately affects Black and Hispanic adults, who are overrepresented among low-income workers in non-expansion states, and drives higher rates of uncompensated care costs at hospitals.

Quick Answers

Which state has the most people without health insurance
Texas has the highest uninsured rate in the U.S. at approximately 16–17%. The state has not expanded Medicaid under the Affordable Care Act, which leaves roughly 1–2 million low-income adults in a coverage gap. Texas also has a large undocumented immigrant population ineligible for most public coverage programs.
Which states have near-universal health coverage
Massachusetts (2.6%) and Hawaii (3.2%) have the lowest uninsured rates. Massachusetts enacted the Health Connector reform in 2006 with an individual mandate, employer requirement, and Medicaid expansion — the template for the ACA. Hawaii has required employers to provide insurance to employees working more than 20 hours per week since 1974.
How does Medicaid expansion affect uninsured rates
States that expanded Medicaid under the ACA (38 states as of 2025) cover adults earning up to 138% of the federal poverty level. Non-expansion states leave a gap for adults above traditional Medicaid eligibility but below income thresholds for marketplace subsidies. Non-expansion states consistently have higher uninsured rates.
Why does having health insurance matter for state comparisons
Uninsured individuals delay or forgo preventive care, leading to worse health outcomes and higher emergency department use. States with higher uninsured rates tend to have lower life expectancy, higher rates of undetected chronic disease, and higher uncompensated care costs shifted to hospitals and insured patients.

Methodology

Uninsured rates represent the percentage of the civilian noninstitutionalized population with no health insurance coverage. Figures are 2023 one-year estimates from the U.S. Census Bureau American Community Survey (ACS), Table B27010.

Sources

Information is cross-referenced with official state archives.
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