Key findings:

  • A repeal of the ACA could leave over 21 million people uninsured with 12 million losing Medicaid coverage.
  • Nationwide, the number of uninsured people has decreased by 37% (17.5 million people) from 2010 to 2019.
  • Medicaid expansion under the Affordable Care Act led to an increase of 23% (12.1 million people) in the number of people enrolled in Medicaid from 2010 to 2019.
  • Rhode Island, Kentucky and West Virginia saw greatest improvement in uninsured rates from 2010 to 2019.
  • South Dakota, Texas and Wyoming saw least improvement in uninsured rates from 2008 to 2017.
  • 39 states have adopted Medicaid expansion, leading to the improved uninsured rates across the nation.

With health insurance open enrollment season on the horizon, we here at QuoteWizard wanted to see which states have made the biggest improvements in reducing uninsured rates. Since the inception of the Affordable Care Act (ACA) in 2010, there have been major improvements to the uninsured rate. From 2010 to 2019 there was a 37% decrease in uninsured Americans, totalling 17.5 million people nationally. The good news is all 50 states saw some level of improvement to their uninsured rates. However, not all states experienced significant increases as some did.

The driving force behind the drop in uninsured rates is likely the expansion of Medicaid under the Affordable Care Act. ACA laws increased eligibility for adults with incomes below 138% of the federal poverty level to be covered under Medicaid. While the ACA increased eligibility for Medicaid, many states have not adopted Medicaid expansion. Currently there are 39 states that have adopted some form of Medicaid expansion. It’s those states who have adopted Medicaid expansion that saw the greatest decrease in uninsured people from 2010 to 2019. Among the top 25 states to decrease their rate of uninsured from 2010 to 2019, all 25 states have adopted Medicaid expansion. As the ACA faces a legal battle in the Supreme Court the insurance status of millions hangs in the balance of a court decision. If the ACA were to be repealed an estimated 21 million people could be left uninsured and over 12 million people could lose Medicaid coverage.

 

To rank states with the largest decrease in uninsured people, we analyzed Kaiser Family Foundation data on health insurance coverage of adults from 2010 to 2019. States are ranked from 1 being the greatest decrease of uninsured to 50 being the lowest decrease of uninsured. We also included the rate of Medicaid increases over the same time period to reflect how the expansion of Medicaid impacts uninsured rates.

Rankings

Rank State 2010 Uninsured 2019 Uninsured % Decrease in Uninsured % Increase in Medicaid
1 Rhode Island 122,300 43,400 -64.51% 21%
2 Kentucky 644,500 275,700 -57.22% 26%
3 West Virginia 262,500 114,500 -56.38% 27%
4 New York 2,258,800 1,000,100 -55.72% 26%
5 California 6,781,300 3,005,400 -55.68% 25%
6 Oregon 645,800 293,500 -54.55% 21%
7 Michigan 1,201,600 561,600 -53.26% 22%
8 New Mexico 403,800 200,500 -50.35% 33%
9 Louisiana 782,900 400,200 -48.88% 29%
10 Illinois 1,757,900 905,900 -48.47% 18%
11 Washington 936,900 488,900 -47.82% 20%
12 Iowa 275,600 144,400 -47.61% 20%
13 Montana 162,800 86,600 -46.81% 21%
14 Arkansas 495,800 265,800 -46.39% 26%
15 Maryland 640,100 347,100 -45.77% 19%
16 Hawaii 100,400 54,500 -45.72% 18%
17 Ohio 1,384,900 760,000 -45.12% 20%
18 Colorado 776,700 436,700 -43.77% 17%
19 Pennsylvania 1,256,400 709,100 -43.56% 20%
20 Vermont 47,000 26,600 -43.40% 24%
21 Minnesota 464,400 265,000 -42.94% 17%
22 Nevada 600,100 349,000 -41.84% 18%
23 New Hampshire 143,500 84,600 -41.05% 13%
24 New Jersey 1,145,200 690,300 -39.72% 17%
25 Indiana 942,400 570,100 -39.51% 18%
26 Wisconsin 530,500 327,000 -38.36% 16%
27 Alaska 124,100 80,500 -35.13% 21%
28 Connecticut 313,800 204,500 -34.83% 22%
29 Virginia 994,400 654,900 -34.14% 14%
30 Idaho 274,900 183,600 -33.21% 16%
31 Alabama 686,800 460,400 -32.96% 20%
32 South Carolina 790,900 539,300 -31.81% 19%
33 Kansas 378,700 259,300 -31.53% 14%
34 Florida 3,924,000 2,757,000 -29.74% 17%
35 Nebraska 210,000 148,300 -29.38% 13%
36 Mississippi 519,100 370,300 -28.66% 24%
37 Delaware 87,200 62,500 -28.33% 20%
38 Utah 422,200 303,700 -28.07% 9%
39 Massachusetts 277,100 202,300 -26.99% 22%
40 North Carolina 1,569,300 1,159,300 -26.13% 18%
41 Georgia 1,863,200 1,379,000 -25.99% 17%
42 Arizona 1,061,900 789,100 -25.69% 21%
43 Tennessee 893,100 676,800 -24.22% 20%
44 Maine 138,500 105,000 -24.19% 20%
45 Missouri 771,400 600,100 -22.21% 14%
46 Oklahoma 699,400 571,000 -18.36% 17%
47 North Dakota 64,900 54,000 -16.80% 12%
48 Wyoming 80,800 69,000 -14.60% 12%
49 South Dakota 93,600 81,500 -12.93% 13%
50 Texas 5,864,200 5,207,000 -11.21% 16%

Methodology

QuoteWizard analyzed health insurance coverage rates in all 50 states to see which states had the greatest improvement in uninsured rates. To get health insurance improvement rates, we compared uninsured rates from 2010 versus 2019 to find which states saw the greatest rate of improvement. States ranked 1 to 50, with 1 being the greatest improvement in uninsured rates and 50 being the lowest rate of improvement. We paired Medicaid increases from 2008 versus 2017 to show a correlation between states that participated in Medicaid expansion and those that saw a greater improvement in uninsured rates.