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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Image: H. Armstrong Roberts
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