Key findings:

  • Nationwide, the number of uninsured people has decreased by 35% (12.6 million people) from 2008 to 2017.
  • Medicaid expansion under the Affordable Care Act lead to an increase of 111% (15.2 million people) in the number of people enrolled in Medicaid from 2008 to 2017.
  • West Virginia, Kentucky and Michigan saw greatest improvement in uninsured rates from 2008 to 2017.
  • South Dakota, Texas and Wyoming saw least improvement in uninsured rates from 2008 to 2017.
  • 35 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 2008 to 2017 there was a 35% decrease in uninsured Americans, totalling 12.6 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 35 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 2008 to 2017. Among the top 20 states to decrease their rate of uninsured from 2008 to 2017, 19 have adopted Medicaid expansion.

Medicaid vs Uninsured trends 2008 to 2017

uninsured health rates

To rank states with the largest decrease in uninsured people, we analyzed Kaiser Family Foundation data on health insurance coverage of adults from 2008 to 2017. 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 (decrease) State 2008 uninsured 2017 uninsured % decrease of uninsured % Medicaid increase
1 West Virginia 244,100 90,800 -63 171
2 Kentucky 507,000 192,000 -62 171
3 Michigan 973,700 427,300 -56 90
4 Rhode Island 91,400 40,700 -55 134
5 Arkansas 424,200 197,800 -53 167
6 California 5,185,500 2,446,600 -53 166
7 New Mexico 334,200 158,900 -52 212
8 Vermont 47,700 23,000 -52 52
9 Oregon 492,000 243,100 -51 276
10 Ohio 1,097,900 542,700 -51 119
11 New York 1,924,400 970,900 -50 82
12 Louisiana 663,400 340,000 -49 183
13 Iowa 212,300 111,400 -48 110
14 Illinois 1,382,700 744,300 -46 91
15 New Hampshire 123,400 66,500 -46 128
16 Colorado 635,000 348,800 -45 270
17 Montana 137,700 77,200 -44 197
18 Minnesota 351,900 197,900 -44 86
19 Washington 690,600 388,400 -44 159
20 Wisconsin 415,100 236,100 -43 50
21 Maryland 519,900 301,000 -42 204
22 Pennsylvania 947,300 550,000 -42 99
23 Hawaii 70,400 41,800 -41 123
24 Arizona 871,400 544,700 -37 89
25 Delaware 69,800 43,900 -37 51
26 Indiana 683,300 435,300 -36 107
27 Connecticut 251,500 168,000 -33 117
28 New Jersey 873,200 586,100 -33 116
29 Nevada 401,100 269,300 -33 397
30 Massachusetts 226,000 158,700 -30 71
31 Alaska 110,000 79,500 -30 236
32 Utah 288,400 209,200 -27 69
33 Kansas 272,000 199,200 -27 76
34 Missouri 631,600 462,800 -27 33
35 Tennessee 709,600 543,200 -23 62
36 Maine 117,600 90,500 -23 -10
37 Idaho 202,400 157,400 -22 150
38 Mississippi 396,000 309,500 -22 52
39 Alabama 529,500 414,500 -22 76
40 Florida 2,916,000 2,292,900 -21 130
41 Georgia 1,449,600 1,155,400 -20 83
42 North Carolina 1,181,000 944,500 -20 78
43 South Carolina 594,500 477,800 -20 78
44 Oklahoma 551,900 452,700 -18 46
45 Virginia 723,500 615,200 -15 75
46 North Dakota 48,400 41,600 -14 76
47 Nebraska 151,200 130,500 -14 49
48 Wyoming 61,000 54,900 -10 103
49 Texas 4,351,000 3,925,600 -10 89
50 South Dakota 66,700 63,600 -5 47

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 2008 versus 2017 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.