Uninsured rate, explained

What it measures

The uninsured rate is the percentage of the civilian non-institutionalized population without any form of health insurance coverage at the time of the survey. Insurance includes employer-sponsored plans, individual market plans (including ACA Marketplace plans), Medicare, Medicaid and CHIP, TRICARE and other military coverage, VA coverage, and Indian Health Service coverage. A person with any of these is "insured"; a person with none is "uninsured."

The Census Bureau began publishing detailed health-insurance data in 2008 as part of the ACS, earlier years used different methodologies. The post-2008 series is comparable across years for federal-program-relevant analysis.

Why it matters

Uninsured rate is the foundational metric of US healthcare policy. The Affordable Care Act, Medicaid expansion, CHIP funding, and Federally Qualified Health Center grants all use uninsured rates as primary inputs. For hospitals, the uninsured rate predicts uncompensated-care load, which drives Disproportionate Share Hospital (DSH) payments and bad-debt expense. The metric also matters for local public-health planning, immunization-program reach, and primary-care provider capacity needs.

How the Census measures it

ACS Table B27001, Health Insurance Coverage Status by Sex by Age. The Census Bureau asks each respondent whether they have any form of health insurance and lists the types as separate yes/no questions. A respondent with any "yes" is insured; respondents with all "no" answers are uninsured. CensusEasy uses the count of uninsured divided by the civilian non-institutionalized population.

How to read the numbers

The US uninsured rate is about 8%, down from about 16% in 2010 (pre-ACA). State rates range from about 3% (Massachusetts, Rhode Island, Hawaii, all early adopters of universal-coverage policy) to over 16% (Texas, Florida, Georgia, Oklahoma, all states that did not expand Medicaid). Among metros, the uninsured rate concentrates heavily in non-Medicaid-expansion states; the highest figures (above 20%) appear in South Texas border metros where a large foreign-born population without immigration status is ineligible for ACA Marketplace subsidies and Medicaid.

Caveats and limitations

The metric is a point-in-time snapshot, people who were uninsured for part of the year but covered at the time of the survey are counted as insured. The Census measures total any-time-of-year insurance status differently in some companion tables. The metric also does not capture the adequacy of coverage; high-deductible plans that leave consumers exposed to substantial cost-sharing are counted the same as comprehensive coverage.