How Did Obamacare Affect the Uninsured Rate in America?
In 2013, the year before the Affordable Care Act's coverage expansion took effect, 45.6 million Americans had no health insurance, 14.9 percent of the country at the time. Today that figure is down to 27.7 million, or 8.4 percent. A difference of roughly 18 million more people with coverage. Both figures come from the Census Bureau.
The gains came in a five-year burst and stopped almost completely after 2019.
The national numbers
| Year | Uninsured rate |
|---|---|
| 2013 | 14.9% |
| 2014 | 14.2% |
| 2015 | 13.0% |
| 2016 | 11.7% |
| 2019 | 8.8% |
| 2022 | 8.7% |
| 2024 | 8.4% |
Between 2013 and 2019 the rate fell 6.1 points. Between 2019 and 2024 it fell by 0.4. The ACA marketplaces and Medicaid expansion did the work in the first stretch. Since then the line has been flat, including through years of low unemployment and before COVID, when more people had job-based coverage available.
Metro areas with the biggest drops
These are the largest metro areas, ranked by how far their uninsured rate fell.
| Rank | Metro area | 2013 | 2024 | Still uninsured |
|---|---|---|---|---|
| 1 | Los Angeles, CA | 21.0% | 7.8% | 1,002,295 |
| 2 | Riverside, CA | 20.2% | 7.8% | 363,239 |
| 3 | Miami, FL | 25.2% | 13.2% | 814,022 |
| 4 | San Diego, CA | 16.8% | 6.4% | 203,475 |
| 5 | Las Vegas, NV | 22.2% | 12.2% | 280,274 |
| 6 | Orlando, FL | 20.7% | 11.0% | 305,457 |
| 7 | Detroit, MI | 12.2% | 4.8% | 207,080 |
| 8 | Atlanta, GA | 18.8% | 12.0% | 742,456 |
| 9 | New York, NY | 12.9% | 6.5% | 1,274,042 |
| 10 | Houston, TX | 23.8% | 18.5% | 1,364,407 |
Los Angeles improved most, from 21.0 percent to 7.8 percent. Atlanta went from 18.8 to 12.0 percent, which still leaves 742,456 people in the metro without coverage.
Medicaid expansion states and the rest
California, Nevada, and Michigan expanded Medicaid early, and their metros show the steepest declines. The states that declined expansion still have the highest uninsured rates in the country.
| Rank | State | 2013 | 2024 |
|---|---|---|---|
| 1 | Texas | 22.8% | 17.1% |
| 2 | Oklahoma | 18.4% | 12.9% |
| 3 | Georgia | 19.0% | 12.4% |
| 4 | Florida | 20.4% | 11.5% |
| 5 | Nevada | 21.7% | 11.4% |
Texas remains the least-insured state in the country at 17.1 percent, roughly double the national rate. Houston alone has 1,364,407 uninsured residents, more than Los Angeles, despite being less than half the size. Dallas adds another 1,282,360.
Boston
Boston went from 4.5 percent uninsured in 2013 to 2.7 percent today, the smallest change of any large metro. Massachusetts passed its own coverage law in 2006, and the ACA was modeled on it. There was not much left for the federal law to fix.
What the census doesn't ask
The census simply asks whether you have health insurance or not. It doesn't ask what you pay for it. Someone who keeps a plan through a higher premium or a bigger deductible still counts as insured.
The people who remain uninsured are concentrated in non-expansion states, in immigrant communities, and among workers whose employers do not offer a plan. Subsidies exist but do not always reach them.
The rankings
You can see the uninsured rate for any place on its data page, or browse the full rankings at highest uninsured states, highest uninsured metros, and highest uninsured counties. The most uninsured people by metro ranking shows raw counts rather than rates. For the national picture across every metric, start at the U.S. overview, or compare two places with the compare tool.
Sources
Figures are the uninsured share of the civilian noninstitutionalized population from the U.S. Census Bureau American Community Survey, table S2701, comparing the 2013 and 2024 five-year estimates. National counts are the Bureau's published totals for those years. Our full method is on the methodology page.
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How many Americans were uninsured before Obamacare?
In 2013, the year before the Affordable Care Act's coverage expansion took effect, 45.6 million Americans had no health insurance, or 14.9 percent of the civilian noninstitutionalized population. Today that figure is 27.7 million, or 8.4 percent, according to Census Bureau data.
Which states still have the most uninsured residents?
Texas has the highest uninsured rate in the country at 17.1 percent, roughly double the national figure, followed by Oklahoma (12.9 percent), Georgia (12.4 percent), Florida (11.5 percent), and Nevada (11.4 percent). Most of the states with the highest rates declined Medicaid expansion.
Has the uninsured rate kept falling?
Not really. The rate fell 6.1 points between 2013 and 2019 but only 0.4 points between 2019 and 2024. The coverage expansion has plateaued, and the census measures whether people have insurance, not what they pay for it, so rising premiums and deductibles do not appear in these figures.
