Across America, millions of adults lack health insurance — and the burden falls unevenly. Some counties have uninsured rates exceeding 30%, meaning nearly one in three residents has no health coverage. We identified the 25 counties with the highest uninsured rates to understand where the coverage gap is most severe.
These counties are heavily concentrated in Texas, Florida, Georgia, and other states that have not expanded Medicaid. The correlation between Medicaid expansion status and county uninsured rates is one of the strongest patterns in American health data.
Counties with the Highest Uninsured Rates
Kenedy County, TX has the highest uninsured rate in America at 37.68%. Texas (23 counties), Ohio (1 counties), Indiana (1 counties) are most represented.
| Rank | County | State | Uninsured Rate | Health Score | PCP per 100K |
|---|---|---|---|---|---|
| 1 | Kenedy County | TX | 37.68% | 0 | N/A |
| 2 | Holmes County | OH | 34.82% | 31.2 | 20.3 |
| 3 | Presidio County | TX | 33.54% | 32.4 | 48.9 |
| 4 | LaGrange County | IN | 33.32% | 36.4 | 24.7 |
| 5 | Gaines County | TX | 31.99% | 17.3 | 9.1 |
| 6 | Hidalgo County | TX | 30.24% | 24.5 | 46.3 |
| 7 | Edwards County | TX | 29.42% | 1 | 69.5 |
| 8 | Ochiltree County | TX | 28.09% | 17 | 40.9 |
| 9 | Swisher County | TX | 28.06% | 4.9 | 14.3 |
| 10 | Dallam County | TX | 27.97% | 7.2 | 83.7 |
| 11 | Sherman County | TX | 27.34% | 35.4 | N/A |
| 12 | San Saba County | TX | 27.23% | 24.6 | 34.3 |
| 13 | Hansford County | TX | 27.11% | 32.9 | 58.2 |
| 14 | Webb County | TX | 27.07% | 21.6 | 30.6 |
| 15 | Crockett County | TX | 26.7% | 9.6 | 65.2 |
| 16 | Yoakum County | TX | 26.65% | 7.5 | 26.3 |
| 17 | Bailey County | TX | 26.58% | 22.3 | 29.3 |
| 18 | Maverick County | TX | 26.26% | 8.4 | 24.1 |
| 19 | Moore County | TX | 26.12% | 16.1 | 33.1 |
| 20 | Collingsworth County | TX | 25.98% | 8.9 | 38.2 |
| 21 | Menard County | TX | 25.8% | 24.8 | 50.5 |
| 22 | Wheeler County | TX | 25.67% | 11.4 | 20.3 |
| 23 | Hudspeth County | TX | 25.63% | 13.5 | N/A |
| 24 | Castro County | TX | 25.29% | 22.2 | 27.1 |
| 25 | Cameron County | TX | 25.22% | 21.1 | 49.2 |
Important
High uninsured rates create a cascade of negative health outcomes: delayed care, reliance on emergency rooms, worse chronic disease management, and medical bankruptcy. Addressing coverage gaps is one of the highest-impact interventions for improving community health.
The Medicaid Expansion Divide
The single largest factor determining whether a county has a high uninsured rate is whether its state expanded Medicaid. In non-expansion states, the coverage gap hits low-income adults who earn too much for traditional Medicaid but too little for marketplace subsidies.
Counties in expansion states have uninsured rates averaging 3-5 percentage points lower than similar counties in non-expansion states. For a county of 100,000 residents, that difference means 3,000-5,000 more people with health coverage.
Methodology
Uninsured rate data comes from CDC County Health Rankings (2024) and U.S. Census Bureau American Community Survey (2019-2023). The rate measures the percentage of adults under 65 without health insurance. Counties are ranked from highest to lowest uninsured rate.
Data sources: CDC County Health Rankings & Roadmaps (2024), a Robert Wood Johnson Foundation program, and U.S. Census Bureau American Community Survey (2019-2023). All figures are estimates and may differ from other published analyses due to methodology differences. This content is informational only and does not constitute medical advice.