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Worst State Uninsured Rates Post-Obamacare


A new analysis of projected uninsured rates post-Affordable Care Act revealed that the states with the largest proportion of uninsured residents are mostly those that did not expand Medicaid coverage.

Insurance rates vary widely state-by-state, but the industry has been having trouble estimating how many enrollees under the Affordable Care Act (ACA) were previously uninsured.

A new analysis from WalletHub revealed estimates of uninsured rates post-ACA for 43 states and the District of Columbia. There were 7 states excluded because of data limitations: Connecticut, Delaware, Maine, Michigan, New Hampshire, North Dakota, and Vermont.

According to the data, blue states (based on how they voted in the 2012 presidential election) have fewer uninsured residents. So do states that chose to expand Medicaid, with an uninsured rate of 10.22% compared to 15.78% for states that did not expand Medicaid.

WalletHub assumed, along with the Kaiser Family Foundation, that 57% of private plan enrollees were previously uninsured. However, RAND estimated the proportion was 28%, McKinsey estimated 36%, and the Department of Health and Human Services (HHS) estimated that the proportion of new enrollees who were uninsured is as high as 87%.

Overall, the national uninsured rate for the non-elderly population decreased from 17.87% to 14.22%, according to WalletHub, which used data from the Kaiser Family Foundation’s study and combined it with information on the number of new Medicaid recipients and private plan enrollees under Obamacare to project uninsured rates post-ACA.

Massachusetts had the lowest rate of uninsured (1 in 100 people), while in the state with the highest rate a quarter of residents lacked insurance even after the ACA was implemented.

10. Georgia

Uninsured rate post-ACA: 18.16%

Uninsured rate pre-ACA: 21.66%

Difference: -3.5%


Georgia is facing more healthcare troubles than just a high rate of residents without insurance. The state is facing the second largest projected primary care physician shortage and needs to increase its workforce by 38% to maintain the status quo. Georgia also has some of the most expensive insurance markets in the country.

9. Wyoming

Uninsured rate post-ACA: 18.29%

Uninsured rate pre-ACA: 18.92%

Difference: -0.63%


Under the HHS’ estimates, Wyoming’s uninsured rate could be as low as 17.56%. However, if looking at RAND’s much more conservative estimates, then Wyoming’s uninsured rate actually increased slightly to 18.99%.

8. Oklahoma

Uninsured rate post-ACA: 18.33%

Uninsured rate pre-ACA: 19.76%

Difference: -1.43%


Oklahoma’s uninsured rate isn’t projected to have much of a change regardless of which organizations estimates are used. RAND only expects the rate to drop to 18.96%, while HHS is more optimistic and projects 17.69%.

7. Alaska

Uninsured rate post-ACA: 18.96%

Uninsured rate pre-ACA: 20.48%

Difference: -1.52%


Alaska is one of the most expensive health insurance marketplaces, which probably didn’t encourage people to sign up under the ACA. The state is also facing one of the largest projected primary care physician shortages and has to increase its workforce by 40% by 2030.

6. Nevada

Uninsured rate post-ACA: 19.58%

Uninsured rate pre-ACA: 26.52%

Difference: -6.94%

Las Vegas

Nevada has the highest projected decrease in its uninsured rate among the state with the largest rate of uninsured. Before the ACA, the percentage of its population without insurance was a close second beyond Texas, which has the highest uninsured rate before the ACA was implemented.

5. New Mexico

Uninsured rate post-ACA: 19.59%

Uninsured rate pre-ACA: 24.29%

Difference: -4.69%


There’s actually not much difference between the various projected uninsured rates from RAND, HHS, McKinsey, and Kaiser. On one end, the uninsured rate was projected to drop down to 19.04%, but on the high end, RAND projected 20.13%.

4. Florida

Uninsured rate post-ACA: 19.61%

Uninsured rate pre-ACA: 24.73%

Difference: -5.12%

Key West

Last year, when looking at the uneven healthcare coverage across the country, Gallup pointed out that Florida as a high Hispanic population, which is the most likely demographic to be uninsured. By 2030, the state will need to increase its primary care physician workforce by 38%.

3. Louisiana

Uninsured rate post-ACA: 20.91%

Uninsured rate pre-ACA: 22.41%

Difference: -1.5%


Along with the majority of states with the highest rates of uninsured, Louisiana did not expand its Medicaid coverage. Another commonality between many of states with the most uninsured, including Louisiana, is that many of them have residents who are considered financially unstable based on their assets, savings, and debt loads.

2. Mississippi

Uninsured rate post-ACA: 21.46%

Uninsured rate pre-ACA: 18.11%

Difference: +3.34%

Meridian. Copyright Nathan Culpepper.

Mississippi is the only state out of all those included that has a projected increase in its uninsured rate post-Obamacare. Mississippi’s projected uninsured rate is also much higher than most states’ uninsured rate was before the ACA.

1. Texas

Uninsured rate post-ACA: 24.81%

Uninsured rate pre-ACA: 26.8%

Difference: -1.99%


Roughly a quarter of Texans lack health insurance, but the state still needs to increase its primary care workforce by 47% by 2030 if it hopes to maintain the status quo.

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