Healthcare Access by County: Insurance, Providers, and Outcomes

Healthcare access is not evenly distributed across America. In some counties, 98% of residents have health insurance and there are more than 200 primary care doctors per 100,000 people. In others, a quarter of the population is uninsured and the nearest doctor is an hour's drive away. We analyzed insurance and provider data for over 3,100 US counties to map these disparities.

The national average uninsured rate across all counties is approximately 10.4%. But this average obscures massive variation — from counties with uninsured rates below 3% to counties where more than 30% of residents lack coverage.

Counties with the Best Insurance Coverage

These counties have the lowest uninsured rates in the country, meaning nearly all residents have access to some form of health coverage:

Counties with the Most Primary Care Providers

Provider density matters as much as insurance coverage. Counties with more primary care physicians per capita have better preventive care, earlier disease detection, and lower emergency room utilization.

The Insurance Desert: Counties with the Highest Uninsured Rates

At the other end of the spectrum, some counties have uninsured rates exceeding 25%. These counties are concentrated in states that have not expanded Medicaid and in border regions with large immigrant populations.

The 10 counties with the highest uninsured rates are: Holmes County, OH (34.82%); Presidio County, TX (33.54%); LaGrange County, IN (33.32%); Gaines County, TX (31.99%); Hidalgo County, TX (30.24%); Edwards County, TX (29.42%); Ochiltree County, TX (28.09%); Swisher County, TX (28.06%); Dallam County, TX (27.97%); San Saba County, TX (27.23%). In these counties, residents often rely on emergency rooms for primary care, leading to worse outcomes and higher costs for the entire healthcare system.

The Rural Provider Shortage

Rural counties face a structural disadvantage in healthcare access. With smaller populations, they struggle to attract and retain physicians, particularly specialists. Many rural counties have zero mental health providers and must rely on telemedicine or require patients to travel to the nearest urban center.

Federal programs like the National Health Service Corps offer loan repayment to physicians who practice in underserved areas, but the shortage persists. The median rural county has roughly half the primary care providers per capita compared to the median urban county.

Insurance Type Matters

Not all insurance is equal. Counties with high rates of employer-sponsored insurance tend to have better health outcomes than those relying heavily on Medicaid or marketplace plans. This reflects both the quality of coverage and the correlation between employment, income, and health.

However, Medicaid expansion has been one of the most significant drivers of reduced uninsured rates at the county level. States that expanded Medicaid under the ACA saw uninsured rates drop by 3-5 percentage points on average, with the largest improvements in historically underserved rural counties.

Methodology

Insurance coverage data comes from the CDC County Health Rankings (2024) and Census Bureau American Community Survey (2019-2023). Primary care physician ratios and mental health provider ratios are from CDC County Health Rankings. All rates are per 100,000 population unless otherwise noted. Health scores use percentile-rank methodology across all 3,143 US counties.