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In Over Half of U.S. Counties, More Working-Age Men Than Women Are Uninsured

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Working-age men have higher uninsured rates compared with women in over half of all U.S. counties (1,662 out of 3,141 counties) as of 2016. Estimates from the American Community Survey show that in 2016, among the working-age population, the uninsured rate was 13.6 percent for men and 10.5 percent for women, a difference of 3.1 percentage points. Does this gap remain when we look at health insurance coverage at the county level?

To answer that question, we used the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE). The SAHIE program provides the only source of single-year estimates of health insurance coverage status for all 3,141 counties in the United States. SAHIE data can be used to analyze geographic variation and annual trends in health insurance coverage, as well as differences in coverage by race, age, income and sex.

Our analysis focuses on U.S. counties for the year 2016, and also examines differences in health insurance coverage between metropolitan and nonmetropolitan counties. We choose working-age adults (ages 18 to 64) specifically because adults age 65 or over and children under 19 are more likely to have health insurance coverage.

In the majority of U.S. counties, a higher proportion of working-age men than women do not have health insurance. In the remaining counties, there was no statistically significant difference in uninsured rates between the two sexes. Additionally, there was no county where working-age women had a statistically significant higher uninsured rate than working-age men (Figure 1).

Figure 1.

Next, we examined if higher rates of men without health insurance coverage are more prevalent among counties inside or outside of metropolitan areas. According to the Office of Management and Budget, a metropolitan statistical area is a core urban area population of 50,000 or more. In 2016, just over a third of counties were inside metropolitan areas, or what we refer to as “metro counties.” A large majority of counties are farther away from urban areas and usually have small populations; we refer to them as “nonmetro counties.” A larger share of counties in metropolitan areas had higher uninsured rates for working-age men than women. Specifically, 64 percent of counties in metropolitan areas (747 out of 1,168 counties) had higher uninsured rates for men compared with 46 percent of counties in nonmetropolitan areas (915 out of 1,973 counties) as seen in Figure 2.

Figure 2.
Share of U.S. Counties Where Working-Age Men Have Higher Uninsured Rates by Metro Status

Another point of interest is whether these results change if we account for low-income working-age men and women. The uninsured are disproportionately prone to living at low-income levels. Here we considered a person low-income if they live at or below 200 percent of poverty. Unlike the total working-age population, differences in uninsured rates between low-income men and women were not statistically significant in the majority of counties. Metro areas continued to exhibit a larger share of counties with higher uninsured rates for men relative to nonmetro areas. There was also no county where low-income working-age women had a higher uninsured rate than men (Figure 3).

Figure 3.
Share of U.S. Counties Where Low-Income Working-Age Men Have Higher Uninsured Rates by Metro Status

Looking at the difference in health insurance coverage between men and women is only one example of how SAHIE data provide timely evaluations of differences in health insurance coverage for all counties. Additional analyses of state- and county-level trends of health insurance coverage status can be found in the 2016 SAHIE report. SAHIE data can be downloaded from the SAHIE application programming interface, offering public access to quality, single-year estimates for U.S. states and counties.

Page Last Revised - October 8, 2021
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