15 States Where the Most People Lack Health Insurance

Since passage of the Affordable Care Act in 2010, the number of uninsured Americans has gone down nationwide. However, some states are doing better than others when it comes to helping their residents obtain health insurance.

While the federal government gave states the option to expand eligibility for Medicaid — a joint federal and state health insurance program primarily for people with low incomes — not all states took Uncle Sam up on the offer.

By and large, those states with the largest share of residents without health insurance are those that chose not to expand their Medicaid programs.

The Census Bureau reports that 8.3% of people nationwide (27.2 million) did not have health insurance at any point in 2021, but the following states all had higher rates. Here’s a look at the states with the largest percentage of uninsured residents.

If you don’t see your state here, see if it lands among the “15 States Where the Most People Have Health Insurance.”

1. Texas

State’s population without health insurance coverage in:

• 2021: 18.0%
• 2019: 18.4%
• 2010: 23.7%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

2. Oklahoma

State’s population without health insurance coverage in:

• 2021: 13.8%
• 2019: 14.3%
• 2010: 18.9%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

3. Georgia

State’s population without health insurance coverage in:

• 2021: 12.6%
• 2019: 13.4%
• 2010: 19.7%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

4. Wyoming

State’s population without health insurance coverage in:

• 2021: 12.2%
• 2019: 12.3%
• 2010: 14.9%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

5. Florida

State’s population without health insurance coverage in:

• 2021: 12.1%
• 2019: 13.2%
• 2010: 21.3%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

6. Mississippi

State’s population without health insurance coverage in:

• 2021: 11.9%
• 2019: 13.0%
• 2010: 18.2%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

7. Nevada

State’s population without health insurance coverage in:

• 2021: 11.6%
• 2019: 11.4%
• 2010: 22.6%

State’s Medicaid expansion status as of Jan. 1, 2021: Expanded

8. Alaska

State’s population without health insurance coverage in:

• 2021: 11.4%
• 2019: 12.2%
• 2010: 19.9%

State’s Medicaid expansion status as of Jan. 1, 2021: Expanded

9. Arizona

State’s population without health insurance coverage in:

• 2021: 10.7%
• 2019: 11.3%
• 2010: 16.9%

State’s Medicaid expansion status as of Jan. 1, 2021: Expanded

10. North Carolina

State’s population without health insurance coverage in:

• 2021: 10.4%
• 2019: 11.3%
• 2010: 16.8%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

11. South Carolina (three-way tie)

State’s population without health insurance coverage in:

• 2021: 10.0%
• 2019: 10.8%
• 2010: 17.5%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

11. Tennessee (three-way tie)

State’s population without health insurance coverage in:

• 2021: 10.0%
• 2019: 10.1%
• 2010: 14.4%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

11. New Mexico (three-way tie)

State’s population without health insurance coverage in:

• 2021: 10.0%
• 2019: 10.0%
• 2010: 19.6%

State’s Medicaid expansion status as of Jan. 1, 2021: Expanded

14. Alabama

State’s population without health insurance coverage in:

• 2021: 9.9%
• 2019: 9.7%
• 2010: 14.6%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded

15. South Dakota

State’s population without health insurance coverage in:

• 2021: 9.5%
• 2019: 10.2%
• 2010: 12.4%

State’s Medicaid expansion status as of Jan. 1, 2021: Not expanded