Key findings:

  • Nationally, the uninsured rate decreased by an average of 37.4% from 2010 to 2019.
  • However, from 2010 to 2016, the uninsured rate decreased by an average of 42.1%, and from 2016 to 2019, it increased by 9.0%.
  • Rhode Island, Kentucky and West Virginia saw the largest overall declines in uninsured rates.
  • The Kaiser Family Foundation (KFF) estimates that 9 million Americans are eligible for reduced or free health insurance under the Affordable Care Act (ACA).
  • As a result of the pandemic, 5.1 million to 9.8 million Americans could be left uninsured.

The Biden administration opened up the Healthcare.gov marketplace to give individuals another chance to sign up for health insurance in 2021. The special enrollment started February 15 and ends on May 15 for most states that expanded the Affordable Care Act (ACA), also known as Obamacare. The Kaiser Family Foundation (KFF) estimates that 9 million Americans are eligible for reduced or free health insurance under the ACA. This reopening is intended to help reduce the number of people uninsured as a result of the pandemic.

Our team of analysts at QuoteWizard wanted to find which states have seen the largest decreases in uninsured residents since the ACA was first enacted. We analyzed KFF data on the uninsured from 2010 to 2019. Our data found that Rhode Island experienced the biggest decrease in uninsured rates among its residents. The state saw a 64.5% decrease over the last decade. Meanwhile, Texas, which ranked at the bottom of our list, only saw an 11.2% drop over the same 10-year period (and a 15.1% increase during the years 2016-2019).

Since the inception of the ACA in 2010, there have been major improvements to uninsured rates across the United States, according to our analysis. Preceding the COVID-19 pandemic, and after the initial expansion of the ACA, the national rate of uninsured declined by an average of 42.1% from 2010 to 2016. However, since 2016, uninsured rates have seen an average increase of 9.0%.

State Ranking of Uninsured Rate Change 2010-2019

Rank State Uninsured rate change 2010-2016 Uninsured rate change 2016-2019 Total rate change in uninsured over the last decade (2010-2019)
1 Rhode Island -64.9% 1.2% -64.5%
2 Kentucky -65.7% 24.9% -57.2%
3 West Virginia -66.6% 30.6% -56.4%
4 New York -48.2% -14.6% -55.7%
5 California -58.1% 5.8% -55.7%
6 Oregon -61.4% 17.9% -54.6%
7 Michigan -57.0% 8.7% -53.3%
8 New Mexico -54.7% 9.6% -50.3%
9 Louisiana -41.1% -13.2% -48.9%
10 Illinois -53.7% 11.2% -48.5%
11 Washington -54.8% 15.4% -47.8%
12 Iowa -55.6% 18.0% -47.6%
13 Montana -47.9% 2.0% -46.8%
14 Arkansas -53.2% 14.5% -46.4%
15 Maryland -44.1% -3.0% -45.8%
16 Hawaii -52.8% 15.0% -45.7%
17 Ohio -54.6% 20.7% -45.1%
18 Colorado -46.7% 5.6% -43.8%
19 Pennsylvania -42.5% -1.9% -43.6%
20 Vermont -54.0% 23.1% -43.4%
21 Minnesota -51.0% 16.5% -42.9%
22 Nevada -46.5% 8.7% -41.8%
23 New Hampshire -42.8% 3.0% -41.0%
24 New Jersey -41.0% 2.1% -39.7%
25 Indiana -44.9% 9.9% -39.5%
26 Wisconsin -44.8% 11.8% -38.4%
27 Alaska -16.6% -22.2% -35.1%
28 Connecticut -45.8% 20.3% -34.8%
29 Virginia -28.2% -8.3% -34.1%
30 Idaho -38.1% 7.9% -33.2%
31 Alabama -36.6% 5.8% -33.0%
32 South Carolina -39.8% 13.3% -31.8%
33 Kansas -37.5% 9.5% -31.5%
34 Florida -35.7% 9.2% -29.7%
35 Nebraska -22.0% -9.5% -29.4%
36 Mississippi -34.6% 9.1% -28.7%
37 Delaware -38.6% 16.8% -28.3%
38 Utah -39.6% 19.0% -28.1%
39 Massachusetts -40.9% 23.4% -27.0%
40 North Carolina -34.4% 12.6% -26.1%
41 Georgia -30.6% 6.7% -26.0%
42 Arizona -36.5% 16.9% -25.7%
43 Tennessee -33.7% 14.4% -24.2%
44 Maine -26.4% 2.9% -24.2%
45 Missouri -31.4% 13.4% -22.2%
46 Oklahoma -25.1% 8.9% -18.4%
47 North Dakota -12.2% -5.3% -16.8%
48 Wyoming -22.6% 10.4% -14.6%
49 South Dakota -26.1% 17.8% -12.9%
50 Texas -22.9% 15.1% -11.2%

Improving access to health care coverage and reducing uninsured rates

Through the special open enrollment period, millions of Americans who lost their employer-based coverage plans may be unaware of their eligibility or how to find affordable or free health insurance. Under the Trump administration, enrollment assistance on the government health insurance marketplace was cut by an average of 84% since 2017. To counter this, the Biden administration has taken the opposite direction regarding the ACA and said they will promote Obamacare. The government wants to spend $50 million on marketing and outreach efforts for the three months, surpassing the $10 million offered by the past administration. To make access even easier, the new administration also removed community service requirements that were previously set in place in exchange for health coverage under the ACA.

The recent announcement to reopen the ACA enrollment as well as reduce the existing barriers to obtain coverage could mean granting health care access to millions without employment or insurance due to the pandemic. At the current rate at which we are experiencing unemployment nationwide, 5.1 million to 9.8 million Americans could be left uninsured. During one of the worst public health emergencies in modern day history, the need for health coverage is imperative.

Although the uninsured population will continue to receive care, the accumulated debt is left with hospitals and health care services. The total cost for treating the uninsured is estimated to be between $13.9 and $41.8 billion, according to KFF. Long-term uninsured rates at this height will likely increase the cost of health care in the future.

The millions left without insurance are likely to create an economic burden on the health care system and the American economy as we know it. In March 2020, Congress enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act to help stabilize the economy. It designated $100 billion (of its $2.2 trillion economic stimulus budget) for funding hospitals and other health care services.

Methodology

To see which states saw the greatest improvement in their uninsured rates, QuoteWizard analyzed KFF data on the uninsured population from 2010 to 2019. States with the largest decreases in uninsured numbers from 2010 to 2019 were ranked closer to 1, while states that saw smaller decreases ranked closer to 50. The year 2010 was chosen due to its being the first year the ACA was enacted, and 2019 is the latest data available. The years 2010-2016 and 2016-2019 were segmented to show how the uninsured rates changed during the two presidential administrations.