How many Americans lack health insurance, and where?
In 2024, 8.2% of the U.S. population had no health insurance — about 1 in 12 people. That figure is up from 7.9% in 2023, a small but statistically significant increase that ended a multi-year stretch of historically low uninsured rates. The U.S. Census Bureau attributes the rise primarily to Medicaid "unwinding": as pandemic-era continuous enrollment protections expired, Medicaid coverage rates fell in 30 states, and not everyone who lost Medicaid moved to other coverage.
But the national average hides a vast gap between states. The uninsured rate ranges from 2.8% in Massachusetts to 16.7% in Texas — a roughly six-fold difference.
Regional patterns
The geography of uninsurance is strongly regional and closely tied to Medicaid expansion decisions under the Affordable Care Act.
- The South and Southwest run highest. Texas (16.7%) stands far apart from every other state. Georgia (12.0%), Oklahoma (11.5%), Florida (10.9%), Mississippi (9.7%) and Tennessee (9.7%) cluster near the top. Several of these — Texas, Georgia, Florida, Mississippi, Tennessee, South Carolina, Wisconsin, Alabama, Kansas — had not expanded Medicaid as of January 2024.
- The Northeast and Upper Midwest run lowest. Massachusetts (2.8%), Vermont (4.2%), Rhode Island (4.6%), New Hampshire (4.5%), New York (5.0%), Minnesota (5.1%) and Michigan (5.1%) anchor the bottom of the table. Hawaii (3.5%) is the lowest outside the Northeast.
- A few non-expansion states buck the trend in either direction, and population mix (age, immigration status, employment) also shapes the numbers.
Notable year-over-year moves
Most states held roughly steady, but a few shifted meaningfully:
- Largest increase: Washington, D.C. rose 1.8 points (2.7% → 4.5%). North Dakota (+1.6), Kentucky (+1.4) and Colorado (+1.2) also jumped.
- Decreases: Only California (6.4% → 5.9%) and North Carolina (9.4% → 8.6%) posted statistically significant declines. North Carolina's drop followed its 2023 Medicaid expansion.
Important caveats
These figures come from the American Community Survey (ACS), a large mandatory Census survey — they are statistically robust but are still survey estimates with margins of error (e.g., ±0.1 for the national rate, ±0.2 for Texas and Massachusetts). The ACS measures coverage at the time of interview, so it differs from "uninsured at any point in the year" estimates. Other federal sources, including the CDC's National Health Interview Survey (NHIS) and the Census Current Population Survey (CPS), use different definitions and methods and can produce slightly different national and state figures. CDC's BRFSS, by contrast, is self-reported and not directly comparable. Comparisons across surveys should be made with care.
*This is a data overview only and is not medical, insurance, or financial advice.*