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As the U.S. continues to grapple with the COVID-19 pandemic, disparities in who has access to healthcare are more pronounced than ever. Though the federal government and many insurers have worked to keep the costs of testing and treating COVID-19 low to manage the broader public health crisis, the impacts of the pandemic on healthcare could be felt for years to come.
One of the most noteworthy challenges over the past year has been widespread losses of jobs and income as a result of COVID-19 shutdowns and business failures. With those economic shocks come reduced access to health insurance. Healthcare coverage is closely linked to employment in the United States, with more than 55% of Americans having employer-sponsored health coverage. Permanent job losses resulting from COVID-19 shutdowns and business failures now total in the millions, which creates an enormous barrier to health insurance coverage for many Americans. And for those who did not already have coverage through an employer and those who find themselves without health insurance due to job loss, the costs of purchasing health policies can be prohibitively expensive.
This situation is especially worrying because the uninsured rate in the U.S. had already been increasing in the past few years. After a dramatic reduction in the number and rate of uninsured in the first few years after the passage of the Affordable Care Act in 2010, both figures began to increase again beginning in 2016. In 2019, the number of uninsured topped 29 million Americans, and data for 2020 and 2021 are likely to be even higher given COVID’s effects.
Another concerning issue is the significant disparities in coverage between different racial and ethnic groups. Non-Hispanic Whites currently have the lowest uninsured rate at 6.3%, followed closely by Asian Americans at 6.6% and people of two or more races at 8.0%. The other racial and ethnic subgroups—American Indians, Hispanic and Latino, Pacific Islanders, and Blacks—all have uninsured rates above 10%. One of the reasons is that people in these groups are more likely to work in lower-wage jobs that do not come with insurance benefits and do not provide enough income to afford private coverage.
Large cities with the highest uninsured rates
1. Houston, TX
- Uninsured rate for residents under 65: 28.1%
- Total residents under 65 without health insurance: 573,715
- Uninsured rate for the unemployed: 57.0%
- Uninsured rate for children under 18: 16.2%
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2. Dallas, TX
- Uninsured rate for residents under 65: 27.3%
- Total residents under 65 without health insurance: 325,228
- Uninsured rate for the unemployed: 55.1%
- Uninsured rate for children under 18: 17.4%
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3. El Paso, TX
- Uninsured rate for residents under 65: 25.1%
- Total residents under 65 without health insurance: 144,769
- Uninsured rate for the unemployed: 57.3%
- Uninsured rate for children under 18: 12.4%
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4. Miami, FL
- Uninsured rate for residents under 65: 22.6%
- Total residents under 65 without health insurance: 86,282
- Uninsured rate for the unemployed: 47.6%
- Uninsured rate for children under 18: 10.3%
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5. Fort Worth, TX
- Uninsured rate for residents under 65: 21.3%
- Total residents under 65 without health insurance: 172,804
- Uninsured rate for the unemployed: 50.5%
- Uninsured rate for children under 18: 13.5%
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6. San Antonio, TX
- Uninsured rate for residents under 65: 20.9%
- Total residents under 65 without health insurance: 279,367
- Uninsured rate for the unemployed: 53.3%
- Uninsured rate for children under 18: 10.1%
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7. Arlington, TX
- Uninsured rate for residents under 65: 20.5%
- Total residents under 65 without health insurance: 72,182
- Uninsured rate for the unemployed: 41.9%
- Uninsured rate for children under 18: 12.4%
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8. Tulsa, OK
- Uninsured rate for residents under 65: 19.2%
- Total residents under 65 without health insurance: 65,075
- Uninsured rate for the unemployed: 52.2%
- Uninsured rate for children under 18: 8.5%
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9. Phoenix, AZ
- Uninsured rate for residents under 65: 17.1%
- Total residents under 65 without health insurance: 253,915
- Uninsured rate for the unemployed: 27.5%
- Uninsured rate for children under 18: 10.6%
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10. Oklahoma City, OK
- Uninsured rate for residents under 65: 16.8%
- Total residents under 65 without health insurance: 93,990
- Uninsured rate for the unemployed: 47.1%
- Uninsured rate for children under 18: 8.0%
Large cities with the lowest uninsured rates
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1. Washington, DC
- Uninsured rate for residents under 65: 3.9%
- Total residents under 65 without health insurance: 23,824
- Uninsured rate for the unemployed: 15.4%
- Uninsured rate for children under 18: 2.0%
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2. San Francisco, CA
- Uninsured rate for residents under 65: 4.3%
- Total residents under 65 without health insurance: 31,822
- Uninsured rate for the unemployed: 14.3%
- Uninsured rate for children under 18: 0.9%
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3. Seattle, WA
- Uninsured rate for residents under 65: 4.6%
- Total residents under 65 without health insurance: 30,191
- Uninsured rate for the unemployed: 12.7%
- Uninsured rate for children under 18: 1.3%
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4. Boston, MA
- Uninsured rate for residents under 65: 4.6%
- Total residents under 65 without health insurance: 28,181
- Uninsured rate for the unemployed: 10.2%
- Uninsured rate for children under 18: 2.4%
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5. San Jose, CA
- Uninsured rate for residents under 65: 6.2%
- Total residents under 65 without health insurance: 54,723
- Uninsured rate for the unemployed: 11.2%
- Uninsured rate for children under 18: 2.0%
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6. Baltimore, MD
- Uninsured rate for residents under 65: 6.6%
- Total residents under 65 without health insurance: 33,133
- Uninsured rate for the unemployed: 18.0%
- Uninsured rate for children under 18: 4.1%
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7. Sacramento, CA
- Uninsured rate for residents under 65: 7.0%
- Total residents under 65 without health insurance: 30,754
- Uninsured rate for the unemployed: 16.3%
- Uninsured rate for children under 18: 3.0%
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8. Louisville, KY
- Uninsured rate for residents under 65: 7.2%
- Total residents under 65 without health insurance: 37,022
- Uninsured rate for the unemployed: 23.2%
- Uninsured rate for children under 18: 3.9%
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9. Oakland, CA
- Uninsured rate for residents under 65: 7.3%
- Total residents under 65 without health insurance: 27,036
- Uninsured rate for the unemployed: 15.1%
- Uninsured rate for children under 18: 4.1%
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10. Minneapolis, MN
- Uninsured rate for residents under 65: 7.4%
- Total residents under 65 without health insurance: 28,307
- Uninsured rate for the unemployed: 13.5%
- Uninsured rate for children under 18: 2.1%
Detailed Findings & Methodology
The data used in this analysis is from the U.S. Census Bureau’s 2019 American Community Survey. To identify cities with the highest uninsured rates, researchers calculated the uninsured rate for residents under 65. In the event of a tie, the location with more total residents under 65 without health insurance was ranked higher. While the city and state-level statistics were calculated for the civilian noninstitutionalized population under 65 only, the uninsured rates by race/ethnicity shown in the charts are for all ages. To improve relevance, only cities with at least 100,000 residents were included. Additionally, cities were grouped into cohorts based on population size: small (100,000–149,999), midsize (150,000–349,999), and large (350,000 or more).
