The U.S. Census Bureau has reported a decline in the rate of people under 65 without health insurance in 194 counties across the United States between 2022 and 2023, while 85 counties saw an increase. These findings are based on the Small Area Health Insurance Estimates (SAHIE), which provide single-year estimates for each of the nation’s 3,143 counties.
SAHIE is currently the only data source offering annual estimates of health insurance coverage for people under age 65 at the county level. The statistics are broken down by sex, age groups, and income levels relevant to state and federal assistance programs like Medicaid. State-level estimates also include information on health coverage by race and Hispanic origin.
“According to SAHIE, 1,455 or 46.3% of U.S. counties had an estimated uninsured rate below 10% in 2023, up from 45.2% of counties in 2022 and 39.2% in 2021.”
Other key points from the SAHIE data include a slight drop in the median county uninsured rate to 9.3% in 2023 from 9.4% in the previous year and from 10.4% in 2021. Uninsured rates among working-age adults (18 to 64) decreased in more than three times as many counties as they increased—182 versus 51—while among children (0 to 18), uninsured rates dropped in just 27 counties but rose in 89.
“Working-age women had lower estimated uninsured rates than working-age men in 62.0% of counties (1,950).”
Additionally, for working-age adults living at or below roughly one-third above the poverty line (138%), there was a continued decrease: “The median county uninsured rate of working-age adults living at or below 138% of poverty was 17.7%, down from 18.6% in 2022 and 20.3% in 2021.”
Further details and interactive tools are available on the Census Bureau website, where users can explore custom tables, maps, and charts covering annual data since 2006.
