Health insurance coverage provides a means for financing health care costs, which helps to increase access to health care services and reduce individual out-of-pocket medical expenses. Across states, levels of health insurance coverage and changes across time may vary due to differences in demographic composition, economic conditions, and the policy environment. Several such policy changes occurred in 2014 when many provisions of the Patient Protection and Affordable Care Act (ACA) went into effect.

This brief uses data from the 2013, 2017, and 2018 American Community Survey 1 year estimates (ACS) to examine health insurance coverage rates in each of the 50 states and the District of Columbia and changes in coverage across years.  The large sample size of the ACS allows for an examination of types of coverage, including private coverage (employment-based, direct purchase, and TRICARE), public coverage (Medicare, Medicaid, CHAMPVA, and VACARE) and the overall insured rate.

• In 2018, private coverage rates across states ranged from 54.3 percent in New Mexico to 79.7 percent in North Dakota (Figure 1).
• Between 2017 and 2018, the percentage of people with private health insurance coverage increased in four states and decreased in four states (Figure 4).
• Public coverage rates in 2018 ranged from 21.3 percent in Utah to 49.4 percent in New Mexico (Figure 1).
• Between 2017 and 2018, the percentage of people with public health insurance coverage increased in 11 states and declined in two states (Figure 4).
• Medicaid coverage varied 22.6 percentage points across states, ranging from 10.3 percent (Wyoming) to 32.9 percent (New Mexico) (Figure 3).
• Private coverage increased in 31 states, and public coverage rates increased in 46 states between 2013 and 2018 (Figure 4).