July 25, 2024 - The rate of Americans under age 65 without health insurance decreased in 627 counties and increased in 23 counties between 2021 and 2022, according to Small Area Health Insurance Estimates (SAHIE) released today by the U.S. Census Bureau.

SAHIE is the only source for single-year estimates of people with health insurance in each of the nation's 3,143 counties. The county statistics are provided by sex and age groups and at income levels reflecting thresholds for state and federal assistance programs, such as the Patient Protection and Affordable Care Act (ACA) and Medicaid eligibility. State estimates also include health coverage by race and Hispanic origin.

According to SAHIE, uninsured rates of Americans under age 65 decreased in 3,037 U.S. counties and rose in three counties from 2013 (the year before many ACA provisions took effect) to 2022. Likewise, 1,422 (45.2%) U.S. counties had an estimated uninsured rate below 10% in 2022, up from 39.2% of counties in 2021 and 4.1% in 2013.

Other SAHIE highlights:

• Estimated county uninsured rates in 2022 ranged from 2.1% to 37.7%, with a median county uninsured rate of 9.4%.
  
• The Northeast and Midwest had the nation's largest share of counties with low (below 10.0%) uninsured rates, and the South had the largest share with high (above 15.0%) uninsured rates.
• County uninsured rates of working-age adults (ages 18 to 64) living at or below 138% of the poverty level ranged from 10.0% to 57.0%. The median county uninsured rate of this population was 18.6%.
• In states that expanded Medicaid eligibility, 10.6% of counties (213 of 2,007) had an estimated uninsured rate above 20% among working-age adults living at or below 138% of poverty, compared to 68.8% of counties (781 of 1,136) in states that didn't expand Medicaid eligibility.
• State uninsured rates varied by race and Hispanic origin. Non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and non-Hispanic Two or More Races populations had lower estimated uninsured rates than Hispanic or Latino populations under age 65 in every state and the District of Columbia.

For more information, visit our interactive data and mapping tool at www.census.gov/data-tools/demo/sahie. This tool allows users to create and download state and county custom tables, thematic maps, and time-trend charts for different geographic levels and demographic groups available annually from 2006 to 2022.

No news release with this report. Tip sheet only.

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