The Town With the Worst Health Insurance Coverage in the Nation

According to the Census Bureau report “Health Insurance Coverage in the United States: 2020,” 8.6% of people did not have health insurance at all last year. That is a total of 28 million people. Who are these people? According to the Kaiser Family Foundation, “non-elderly” adults who are in working families.

Using data from the U.S. Census Bureau, 24/7 Tempo identified the town with the worst health insurance coverage. Towns are ranked based on the share of residents under age 65 (the age of eligibility for Medicare) who are uninsured. We included cities, towns, villages and unincorporated communities with populations between 1,000 and 25,000 in our analysis.

Uninsured rates in the places on this list range from less than 40% to nearly 60%. The majority of the towns on this list are in southern states, including 26 in Texas alone.

Arivaca Junction, Arizona, is the town with the worst health insurance coverage. Here are the details:

• No health insurance: 59.5%
• Medicare coverage: 0.7% (700th lowest)
• Medicaid coverage: 21.9% (5,313th highest)
• VA coverage: 0.0% reported (tied for lowest)
• Employer-based insurance: 8.6% (sixth lowest)
• Direct-purchase insurance: 9.3%(4,921st highest)
• Tricare/military insurance: 0.0% reported (tied for lowest)

Methodology: To determine the town with the best health insurance coverage in the nation, 24/7 Wall St. reviewed five-year estimates of the percentage of the noninstitutionalized civilian population under 65 without health insurance from the Census Bureau’s 2019 American Community Survey (ACS).

We used census “place” geographies. That category includes 29,573 incorporated legal entities and census-designated statistical entities. Of those, 29,320 had boundaries that fell within one of the 50 states or the District of Columbia.

We defined towns based on population thresholds (having at least 1,000 people and less than 25,000 people), and 13,332 of the places fell within these thresholds.

Towns were excluded if the noninstitutionalized civilian population under 65 was less than 1,000, or if the sampling error associated with a town’s data was deemed too high.

The sampling error was defined as too high if the coefficient of variation (a statistical assessment of how reliable an estimate is) for a town’s under 65 uninsured rate was above 15% and greater than two standard deviations above the mean coefficient of variation for all towns’ under 65 uninsured rates. We similarly excluded towns that had a sampling error too high for their under 65 noninstitutionalized civilian population, using the same definition.

We selected the under 65 age group because Americans become eligible for Medicare at age 65, and the uninsured rate for the population above this age is less than 1% nationwide. However, because the Census Bureau doesn’t publish insurance coverage estimates specifically for the under 65 age group, we aggregated the data from more granular age breakdowns.

To ensure each aggregate estimate’s sampling error could be assessed using the definition above, we derived a margin of error for each aggregate estimate using the successive differences replication variance estimation methodology recommended and used by the Census Bureau.

The remaining 11,039 places were ranked based on their under 65 uninsured rates. To break ties, we used the number of insured people in the same population group.

The share of the population covered by each type of insurance (Medicare, Medicaid, VA, employer, direct-purchase and Tricare/military) are for the same cohort and are also aggregated from five-year ACS estimates. The estimates reflect people who are covered by that type of insurance alone or in combination with other types on the list. So, when a person is covered by more than one type of insurance, they are included in each group.

Click here to see all the towns with the worst health insurance coverage in the country.

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