Prevention

Lack of Health Insurance (Adults 18-64) by County — US Rankings

CDC PLACES 2023 · Age-adjusted prevalence · All 3,144 US counties

The CDC reports this measure as the share of adults aged 18-64 currently without any form of health insurance — distinct from the broader uninsured-rate measure already shown on each county page, which uses Census ACS data and covers all ages. PLACES uses BRFSS, which produces somewhat different estimates: the two should not be expected to match exactly. The county-level pattern is dominated by state Medicaid expansion policy. Counties in non-expansion states cluster at the top of this ranking, particularly along the Texas-Louisiana-Mississippi belt and across the Southeast.

How this ranking is built

Source: CDC PLACES 2023 release. Methodology: BRFSS survey responses pooled across years, fitted with a small-area statistical model, age-adjusted to the 2000 US standard population. Confidence intervals (95%) are shown for each county — wider intervals indicate more uncertainty in the modeled estimate, typically driven by smaller populations.

Lowest Lack of Health Insurance (18-64) Rates — Top 100 Counties

Counties with the lowest reported lack of health insurance (18-64) prevalence — these counties show the most favorable position on this measure.

#CountyRate
1Norfolk County4.0%
2Barnstable County4.1%
3Middlesex County4.1%
4Dukes County4.2%
5Hampshire County4.5%
6Plymouth County4.7%
7Nantucket County4.8%
8Saratoga County4.9%
9Tompkins County4.9%
10Franklin County5.0%
11Livingston County5.1%
12Berkshire County5.2%
13Keweenaw County5.2%
14Falls Church city5.2%
15Honolulu County5.3%
16Leelanau County5.3%
17Delaware County5.3%
18Washington County5.3%
19Hamilton County5.4%
20Washtenaw County5.4%
21Chittenden County5.4%
22Oakland County5.5%
23Bristol County5.5%
24Dallas County5.6%
25Emmet County5.6%
26Worcester County5.7%
27Grand Traverse County5.7%
28Albany County5.7%
29Madison County5.7%
30Warren County5.7%
31Ontario County5.8%
32Newport County5.8%
33Placer County5.9%
34Charlevoix County5.9%
35Los Alamos County5.9%
36Rensselaer County5.9%
37Ozaukee County5.9%
38Monroe County6.0%
39Warren County6.0%
40Howard County6.0%
41Midland County6.0%
42Nevada County6.1%
43Boone County6.1%
44Bremer County6.1%
45Dickinson County6.1%
46Antrim County6.1%
47Clinton County6.1%
48Marquette County6.1%
49Carver County6.1%
50Washington County6.1%
51Cortland County6.1%
52Erie County6.1%
53Livingston County6.1%
54Niagara County6.1%
55Onondaga County6.1%
56Grand Isle County6.1%
57Washington County6.1%
58Waukesha County6.1%
59El Dorado County6.2%
60Marin County6.2%
61San Francisco County6.2%
62District of Columbia6.2%
63Grundy County6.2%
64Marion County6.2%
65Benzie County6.2%
66Columbia County6.2%
67Genesee County6.2%
68Hamilton County6.2%
69Tioga County6.2%
70Cass County6.2%
71Windsor County6.2%
72Arlington County6.2%
73Alpine County6.3%
74Madison County6.3%
75Mills County6.3%
76Story County6.3%
77Winneshiek County6.3%
78Bristol County6.3%
79Dickinson County6.3%
80Rockingham County6.3%
81Essex County6.3%
82Herkimer County6.3%
83Monroe County6.3%
84Otsego County6.3%
85Steuben County6.3%
86Warren County6.3%
87Addison County6.3%
88Warrick County6.4%
89Johnson County6.4%
90Allegany County6.4%
91Nassau County6.4%
92Schenectady County6.4%
93Schoharie County6.4%
94Lamoille County6.4%
95St. Croix County6.4%
96Woodford County6.5%
97Benton County6.5%
98Essex County6.5%
99Suffolk County6.5%
100Houghton County6.5%

Best 100 counties for Lack of Health Insurance (18-64).

Highest Lack of Health Insurance (18-64) Rates — Bottom 100 CountiesCounties with the highest reported lack of health insurance (18-64) prevalence.
#CountyRate
1Starr County43.7%
2Zapata County43.3%
3Zavala County42.8%
4Dimmit County41.6%
5Jim Hogg County41.3%
6Willacy County40.7%
7Maverick County39.0%
8La Salle County39.0%
9Brooks County38.0%
10Reeves County37.5%
11Hidalgo County37.5%
12Hudspeth County36.9%
13Kenedy County36.5%
14Frio County36.5%
15Webb County36.3%
16Cameron County36.3%
17Duval County35.9%
18Presidio County35.5%
19Deaf Smith County35.1%
20Jim Wells County33.5%
21Cochran County33.1%
22Val Verde County32.3%
23Culberson County32.0%
24Hendry County31.9%
25Pecos County31.3%
26Garza County31.0%
27Crane County31.0%
28Bailey County30.6%
29Dawson County29.8%
30Terry County29.7%
31Crockett County29.6%
32Parmer County29.5%
33Moore County29.5%
34Hale County29.3%
35El Paso County29.1%
36Uvalde County28.9%
37Floyd County28.8%
38Sutton County28.6%
39Winkler County28.4%
40Castro County28.4%
41Lamb County28.3%
42Crosby County28.3%
43Kleberg County28.2%
44Atascosa County28.0%
45Upton County27.8%
46Karnes County27.8%
47Ector County27.8%
48Yoakum County27.6%
49Reagan County27.5%
50Dallam County27.5%
51Bee County27.4%
52Edwards County27.3%
53DeSoto County27.0%
54Gonzales County26.9%
55Swisher County26.8%
56Stewart County26.7%
57Ochiltree County26.6%
58Luna County26.6%
59Hardee County26.6%
60Santa Cruz County26.5%
61Ward County26.4%
62Caldwell County26.4%
63Miami-Dade County26.2%
64Andrews County26.1%
65Atkinson County26.0%
66Kinney County25.9%
67Gaines County25.8%
68Refugio County25.7%
69Live Oak County25.6%
70Titus County25.5%
71San Patricio County25.4%
72Seward County25.1%
73Nueces County25.0%
74Guadalupe County24.7%
75Glades County24.5%
76Adams County24.2%
77Liberty County24.1%
78Yuma County24.1%
79Potter County24.0%
80Hansford County24.0%
81Concho County24.0%
82Mitchell County23.9%
83Howard County23.9%
84Nolan County23.8%
85Hockley County23.8%
86Schleicher County23.7%
87Matagorda County23.6%
88Telfair County23.4%
89Calhoun County23.1%
90McMullen County23.0%
91Hall County23.0%
92Victoria County22.9%
93Whitfield County22.7%
94Medina County22.6%
95Lynn County22.4%
96Menard County22.3%
97DeWitt County22.3%
98Bastrop County22.3%
99Bent County22.3%
100Martin County22.2%

Worst 100 counties for Lack of Health Insurance (18-64).

What this ranking suggests

Insurance status is the single strongest moderator of every clinical-prevention measure on this site. Counties at the top of the uninsured ranking will tend to show lower cholesterol screening, lower mammography, lower routine checkup, and higher diagnosed-but-untreated chronic disease — patterns that show up across the other PLACES rankings.

Methodology notes & limitations

Estimates are statistical model outputs, not direct measurements. Small counties have wider confidence intervals; treat narrow rank differences in those rows as within-noise. Counties where the underlying population is too small to support modeling are suppressed entirely (about 1% of US counties). All measures are age-adjusted to the 2000 US standard population. The PLACES dataset uses BRFSS self-reported data — self-report introduces known direction-of-bias in some measures (BMI is under-reported; binge drinking is under-reported), but the bias is roughly uniform across counties so ranking comparability is preserved. See the methodology page for full data-pipeline documentation.

By Logan Johnson, Founder & Data EditorPublished Reviewed by Logan Johnson, Founder & Data Editor

Data source: CDC PLACES 2023 release. Measure ID: ACCESS2.

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