Of the 20 counties in the U.S. with the lowest health insurance coverage, 19 are in Texas, according to a recent study from SmartAsset ranking 810 U.S. counties based on the rate of people under age 65 who were insured in 2024.
More than any other county, 32.0% of residents in Hidalgo County, Texas, don’t have health insurance. Cameron County (30.1% uninsured), Webb County (29.7%), Starr County (29.0%), Ector County (25.3%), Potter County (24.4%), Dallas County (24.2%), Harris County (23.8%) and El Paso County (23.5%)—all in Texas—are also among the top 10 most uninsured counties nationwide.
Whitfield County, Ga., which came in at No. 10 with a 23.4% rate, was the only county not in Texas to be included among the 20 most uninsured.
One the other end of the spectrum, Massachusetts dominates the rankings for high rates of health insurance coverage with more than 96% of the population having health insurance. Norfolk County has the highest rate of insurance at 97.6%. Statewide, more than 98.5% of children under age 19 have health insurance.
In fact, 9 of the top 10 counties with the highest rates of coverage were in Massachusetts. Carver County, Minn., was the only non-Massachusetts county in the top 10 at No. 6 with an uninsured rate of 3.08%.
In 2024, the study found the average annual premium for a single individual was nearly $9,000—and an estimated $25,500 for a family of four. While many workplaces subsidize these premiums, and the Affordable Care Act opened access to healthcare for Americans not covered by employer plans, health insurance is still often a costly budget item that some individuals may forgo. In these cases, Americans may be making tradeoffs between their health and their financial wellbeing, SmartAsset said.
More key findings
- These counties have the highest and lowest rate of primary care physicians: Orange County, Texas, ranking 84th overall for lowest rate of health insurance among the population, has 6,053 residents per primary care physician—more than any other county studywide. On the other hand, 18th place Smith County, Texas, has the smallest number of residents per primary care physician studywide at 1,014.
- The biggest swings in coverage year over year happened in these counties: Relative to the population, Tom Green County, Texas (25th highest rank of uninsured residents) saw the biggest drop in insurance coverage, going from 17.5% uninsured in 2023 to 20.2% uninsured in 2024. Meanwhile, Elkhart County, Ind., saw the biggest relative improvement in insurance coverage, going from 16.6% uninsured in 2023 to 13.3% uninsured in 2024.
Data included in the SmartAsset report is for 2024 and comes from County Health Rankings & Roadmaps. Data was examined for the largest 810 counties for which data was available.
