In 2018 the number of people with health insurance decreased, for the first time since the Affordable Care Act passed in 2010.

Federal policy has played a role. Congress suspended the tax penalty for the individual mandate and the Trump administration decreased the length of open enrollment and cut the advertising budget.

States play a large role in health insurance coverage as well. Insurance companies are regulated at the state level and states choose how to run Medicaid, including deciding whether to expand coverage to those making below a certain income level. (Learn the rules for qualifying for Medicaid in your state.)

Policies vary by state. So does insurance coverage.

We looked at estimates from the Census Bureau's 2018 American Community Survey to see which states had the lowest rates of insured residents.

1. Texas

Percent insured: 82.3% Number of uninsured people: 5 million

2. Oklahoma

Percent insured: 85.8% Number of uninsured people: 548,316

3. Georgia

Percent insured: 86.3% Number of uninsured people: 1.41 million

4. Florida

Percent insured: 87% Number of uninsured people: 2.73 million

5. Alaska

Percent insured: 87.4% Number of uninsured people: 90,128

6. Mississippi

Percent insured: 87.9% Number of uninsured people: 354,151

7. Nevada

Percent insured: 88.8% Number of uninsured people: 336,191

8. Idaho

Percent insured: 88.9% Number of uninsured people: 192,620

9. North Carolina

Percent insured: 89.3% Number of uninsured people: 1.09 million

10. Arizona

Percent insured: 89.4% Number of uninsured people: 749,977

11. South Carolina

Percent insured: 89.5% Number of uninsured people: 522,459

12. Wyoming

Percent insured: 89.5% Number of uninsured people: 59,337

13. Tennessee

Percent insured: 89.9% Number of uninsured people: 674,865

14. Alabama

Percent insured: 90% Number of uninsured people: 481,259

15. South Dakota

Percent insured: 90.2% Number of uninsured people: 84,707

16. New Mexico

Percent insured: 90.5% Number of uninsured people: 196,250

17. Missouri

Percent insured: 90.6% Number of uninsured people: 566,327

18. Utah

Percent insured: 90.6% Number of uninsured people: 295,364

19. Virginia

Percent insured: 91.2% Number of uninsured people: 731,469

20. Kansas

Percent insured: 91.2% Number of uninsured people: 250,355

21. Indiana

Percent insured: 91.7% Number of uninsured people: 545,123

22. Nebraska

Percent insured: 91.7% Number of uninsured people: 157,612

23. Arkansas

Percent insured: 91.8% Number of uninsured people: 243,585

24. Montana

Percent insured: 91.8% Number of uninsured people: 86,029

25. Louisiana

Percent insured: 92% Number of uninsured people: 363,362

26. Maine

Percent insured: 92% Number of uninsured people: 106,187

27. Colorado

Percent insured: 92.5% Number of uninsured people: 421,644

28. New Jersey

Percent insured: 92.6% Number of uninsured people: 655,000

29. North Dakota

Percent insured: 92.7% Number of uninsured people: 53,935

30. California

Percent insured: 92.8% Number of uninsured people: 2.83 million

31. Oregon

Percent insured: 92.9% Number of uninsured people: 293,107

32. Illinois

Percent insured: 93% Number of uninsured people: 874,608

33. Ohio

Percent insured: 93.5% Number of uninsured people: 743,905

34. Washington

Percent insured: 93.6% Number of uninsured people: 477,284

35. West Virginia

Percent insured: 93.6% Number of uninsured people: 114,106

36. Maryland

Percent insured: 94% Number of uninsured people: 356,708

37. New Hampshire

Percent insured: 94.3% Number of uninsured people: 77,011

38. Delaware

Percent insured: 94.3% Number of uninsured people: 53,962

39. Kentucky

Percent insured: 94.4% Number of uninsured people: 247,641

40. Pennsylvania

Percent insured: 94.5% Number of uninsured people: 699,376

41. Wisconsin

Percent insured: 94.5% Number of uninsured people: 313,158

42. New York

Percent insured: 94.6% Number of uninsured people: 1.04 million

43. Michigan

Percent insured: 94.6% Number of uninsured people: 534,551

44. Connecticut

Percent insured: 94.7% Number of uninsured people: 186,923

45. Iowa

Percent insured: 95.3% Number of uninsured people: 147,039

46. Minnesota

Percent insured: 95.6% Number of uninsured people: 244,379

47. Hawaii

Percent insured: 95.9% Number of uninsured people: 55,799

48. Rhode Island

Percent insured: 95.9% Number of uninsured people: 42,481

49. Vermont

Percent insured: 96% Number of uninsured people: 24,988

50. District of Columbia

Percent insured: 96.8% Number of uninsured people: 21,897

51. Massachusetts

Percent insured: 97.2% Number of uninsured people: 188,907

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