August 3, 2023 — The rate of Americans under age 65 without health insurance decreased in 280 counties and increased in 80 counties between 2020 and 2021, according to new data released today by the U.S. Census Bureau.

The new data come from the Small Area Health Insurance Estimates (SAHIE) program, the only source for single-year estimates of people with health insurance in each of the nation’s 3,142 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 data by race and Hispanic origin. In addition to data for White, Black or African American, and Hispanic or Latino populations, this is the first SAHIE release to include health insurance estimates for the following race groups: American Indian and Alaska Native, Asian, Native Hawaiian and Other Pacific Islander, and Two or More Races.

According to SAHIE, uninsured rates of Americans under age 65 decreased in 2,906 U.S. counties and rose in 10 counties from 2013 (the year before many ACA provisions took effect) to 2021. Likewise, 1,231 (39%) U.S. counties had an estimated uninsured rate below 10% in 2021, up from 34% of counties in 2020 and 4% in 2013.

Other SAHIE highlights:

• Estimated county uninsured rates ranged from 2.4% to 46.3%, with a median county uninsured rate of 10.4%.
• 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 4.9% to 64.1%. The median county uninsured rate among this population was 20.3%.
• In states that expanded Medicaid eligibility, 17.2% of counties (346 of 2,006) had an estimated uninsured rate above 20% among working-age adults living at or below 138% of poverty, compared to 82.9% of counties (942 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 2021.

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