Where uninsured rates have fallen the most since 2013
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Uninsured rates hit record lows in all U.S. states by 2023, driven by coverage expansions under the Affordable Care Act and related policy changes, per a new report.
Why it matters: Although a greater share of people now have some form of health insurance, many remain uninsured — particularly in states that haven't expanded Medicaid access.
Driving the news: The uninsured rate for working-age U.S. adults dropped from 20.4% in 2013 to 11% in 2023, according to an analysis of census data from the Commonwealth Fund, a health care foundation.
- California (-15 percentage points), New Mexico (-14.9) and Louisiana (-14.7) had the biggest drops over that period — meaning more residents are now insured.
- Washington, D.C. (3.4%), Massachusetts (3.6%) and Hawai'i (3.9%) had the lowest uninsured rates as of 2023.
Caveat: Places that already enjoyed relatively low uninsured rates in 2013, like Massachusetts and D.C., had less room for improvement over the following decade.
Reality check: Despite these gains, some states still have high rates of uninsured working-age adults.
- In Texas, for example, the uninsured rate is 21.6% as of 2023 — meaning about one in five adults lacks health coverage.
Context: Under the ACA, states can expand Medicaid coverage to adults with incomes up to 138% of the federal poverty level.
- 10 states have not done so.
Zoom in: The states that still have relatively high uninsured rates "generally haven't expanded Medicaid," per the report, which compares the cases of Kentucky and Tennessee.
- In Kentucky, which was quick to expand Medicaid, "the uninsured rate for people with incomes under 200% of poverty fell by two-thirds between 2013 and 2023," the report says.
- "By contrast, in Tennessee, which has not expanded Medicaid, the uninsured rate for the same group of low-income adults declined by only one-third."
Zoom out: Many residents of states that haven't expanded Medicaid can still get covered under ACA marketplace plans.
- Yes, but: About 1.4 million residents of those states are stuck in the "coverage gap," the report notes, failing to qualify for either ACA plans or Medicaid.
Between the lines: About 5 million uninsured people are ineligible for coverage under ACA expansions because of their immigration status, affecting the overall numbers in states with many residents lacking legal status.
What's next: Congressional Republicans have been pushing for significant Medicaid cuts and changes that could result in millions of Americans losing their coverage.
