According to the Census Bureau report “Health Insurance Coverage in United States: 2020,” 8.6% of people had no health insurance at all last year. That’s a total of 28 million people. Who are these people? According to the Kaiser Family Foundation, “non-elderly” adults who are part of working families.
Using data from the US Census Bureau, 24/7 Tempo identified the city with the worst health insurance coverage. Cities are ranked based on the proportion of residents under age 65 (the age of Medicare eligibility) who are uninsured. We included in our analysis towns, cities, towns and unincorporated communities with a population of between 1,000 and 25,000.
The uninsured rates at the places on this list range from less than 40% to almost 60%. The majority of cities on this list are in the southern states, including 26 in Texas alone.
Arivaca Junction, Arizona, is the city with the worst health insurance coverage. Here are the details:
- No health insurance: 59.5%
- Health insurance coverage: 0.7% (700th lowest)
- Medicaid coverage: 21.9% (5,313rd highest)
- VA coverage: 0.0% reported (tied for lowest)
- Employers’ insurance: 8.6% (sixth lowest)
- Direct purchase insurance: 9.3% (4,921st higher)
- Tricare / military insurance: 0.0% declared (tied for the lowest)
Methodology: To determine the city with the best health insurance coverage in the country, 24/7 Wall St. examined five-year estimates of the percentage of the non-institutionalized civilian population under the age of 65 without health insurance as of ‘American Community Survey 2019 from the Census Bureau (ACS).
We used census “place” geographies. This category includes 29,573 incorporated legal entities and statistical entities designated by census. Of these, 29,320 had borders that fell under one of the 50 states or the District of Columbia.
We defined cities according to population thresholds (having at least 1,000 inhabitants and less than 25,000 inhabitants), and 13,332 of the places fell within these thresholds.
Cities were excluded if the non-institutionalized civilian population under 65 was less than 1,000 or if the sampling error associated with the data for one city was deemed too high.
Sampling error was defined as too high if the coefficient of variation (a statistical assessment of the reliability of an estimate) for the uninsured rate for a city under 65 was greater than 15% and greater to two standard deviations above the average coefficient of variation for all cities’ less than 65 uninsured rates. We also excluded cities that had too high a sampling error for their non-institutionalized civilian population under 65, using the same definition.
We selected the under 65 age group because Americans become Medicare eligible at age 65 and the uninsured rate for the population above that age is less than 1% on the scale. national. However, because the Census Bureau does not publish insurance coverage estimates specifically for the under 65 age group, we aggregated the data from more granular age breakdowns.
To ensure that the sampling error of each aggregate estimate can be assessed using the definition above, we calculated a margin of error for each aggregate estimate using the estimation methodology of the variance by replication by successive differences recommended and used by the Census Bureau.
The remaining 11,039 places have been classified according to their uninsured rates for those under 65. To break the ties, we used the number of insureds from the same population group.
The share of the population covered by each type of insurance (Medicare, Medicaid, VA, Employer, Direct Purchase and Tricare / Military) is for the same cohort and is also aggregated from ACS estimates over five years. The estimates reflect the people covered by this type of insurance alone or in combination with other types on the list. Thus, when a person is covered by more than one type of insurance, he is included in each group.
Click here to see all the cities with the worst health insurance coverage in the country.