This report is an original analysis produced by CoverShield Research, a division of CoverShield (covershield.live) — a free insurance comparison and referral service connecting Americans with licensed health insurance agents. Our data are drawn from the U.S. Census Bureau's American Community Survey (ACS) 2023 1-Year Estimates (Table S2701) and supplementary state-level data published by the Kaiser Family Foundation (KFF) State Health Facts program. All figures reflect the most current publicly available data at the time of publication (May 2026) and represent the percentage of the total population that lacked health insurance coverage at any point during 2023.
Understanding where uninsurance is concentrated matters for consumers, policymakers, employers, and advocates alike. Being uninsured exposes individuals to catastrophic financial risk — a single emergency room visit averages $2,600, and a surgical hospitalization can exceed $30,000. CoverShield publishes this research to help Americans understand their risk, explore their options, and take action. If you or someone you know lacks health coverage, get a free insurance quote at covershield.live or contact our helpline — our licensed agents compare 40+ carriers at no cost to you.
Data sources: U.S. Census Bureau, ACS 2023 1-Year Estimates, Table S2701; KFF State Health Facts, Health Insurance Coverage of the Total Population, 2023.
Despite the Affordable Care Act's landmark expansion of coverage options and Medicaid eligibility, more than 25 million non-elderly Americans remained without health insurance in 2023, according to the U.S. Census Bureau's American Community Survey. The national uninsured rate stood at 7.9% — roughly 1 in 13 Americans — masking enormous variation across states, income levels, and demographic groups. (Source: 2023 ACS, U.S. Census Bureau)
The financial consequences of going without coverage are severe. The uninsured are often billed at "chargemaster" rates — full list prices that are 2 to 3 times higher than the negotiated rates paid by insured patients. A routine ER visit averaging $2,600 can become a financial crisis for an uninsured household. For those requiring surgery, the average bill exceeds $30,000. Medical debt has become the leading cause of personal bankruptcy in the United States, a burden that falls disproportionately on residents of the highest-uninsured states. (Source: KFF, SHADAC, HHS ASPE)
The geographic concentration of uninsurance is stark: just 10 states account for a disproportionate share of the uninsured population, and nearly all of them are in the South or Mountain West — regions that have historically lagged on Medicaid expansion and marketplace enrollment outreach.
Sources: U.S. Census Bureau ACS 2023; KFF State Health Facts 2023; SHADAC 2023 ACS State Uninsured Rates.
The chart below ranks all 50 states and the District of Columbia from highest to lowest uninsured rate, using 2023 ACS 1-Year Estimates. Bars are color-coded by severity: red (>10%), orange (7%–10%), and green (<7%). The vertical reference line marks the national average of 7.9%.
Source: U.S. Census Bureau, American Community Survey, 2023 1-Year Estimates (Table S2701). Data represent percentage of total population (all ages) without health insurance coverage. Published by CoverShield Research | covershield.live.
The ten states below have the highest uninsured rates in the nation. Seven of the ten have not fully expanded Medicaid under the ACA, leaving hundreds of thousands of low-income adults in a coverage gap. CoverShield licensed agents can often find affordable coverage options — enrolled consumers save an average of $612 per year compared to going uninsured and paying out-of-pocket rates.
| Rank | State | Uninsured Rate (2023) | Rate vs. National Avg | Medicaid Expansion | Est. Annual Savings* |
|---|---|---|---|---|---|
| 1 | Texas | +8.5 pts above avg | Not Expanded | ~$612/yr | |
| 2 | Oklahoma | +5.2 pts above avg | Expanded | ~$612/yr | |
| 3 | Georgia | +4.3 pts above avg | Partial | ~$612/yr | |
| 4 | Wyoming | +3.6 pts above avg | Not Expanded | ~$612/yr | |
| 5 | Florida | +3.3 pts above avg | Not Expanded | ~$612/yr | |
| 6 | Mississippi | +3.1 pts above avg | Not Expanded | ~$612/yr | |
| 6 | Nevada | +3.1 pts above avg | Expanded | ~$612/yr | |
| 8 | Alaska | +2.9 pts above avg | Expanded | ~$612/yr | |
| 9 | South Carolina | +2.7 pts above avg | Not Expanded | ~$612/yr | |
| 10 | Idaho | +2.5 pts above avg | Expanded | ~$612/yr |
* Estimated annual savings based on average cost difference between paying out-of-pocket uninsured rates vs. subsidized marketplace coverage through CoverShield. Individual savings vary. Medicaid expansion status: KFF State Health Facts, 2023. Uninsured rates: 2023 ACS, U.S. Census Bureau.
The ACA's Medicaid expansion provision — which extends coverage to adults earning up to 138% of the federal poverty level — has been one of the most powerful tools for reducing uninsurance. States that expanded Medicaid saw an average uninsured rate of approximately 5.7% in 2023, nearly half the 11.2% average recorded in non-expansion states. The gap of roughly 5.5 percentage points represents a massive structural disparity in access to care, driven entirely by state policy decisions. (Source: KFF State Health Facts, 2023; 2023 ACS, U.S. Census Bureau)
The "Medicaid coverage gap" describes individuals who earn too little to qualify for ACA marketplace subsidies (below 100% FPL) but live in states that haven't expanded Medicaid, leaving them ineligible for either program. As of 2023, the states of Texas, Florida, Georgia (partial), Wyoming, Mississippi, Tennessee, Alabama, South Carolina, and Kansas had not adopted full Medicaid expansion — and their residents pay the price in higher uninsurance rates and greater medical debt exposure. (Source: KFF, "Status of State Medicaid Expansion Decisions," 2023)
CoverShield Note: Even in non-expansion states, many residents qualify for subsidized ACA marketplace plans. Our licensed agents can determine your eligibility in minutes. Visit covershield.live to compare plans from 40+ carriers.
Sources: KFF State Health Facts, Medicaid Expansion Status 2023; U.S. Census Bureau ACS 2023 1-Year Estimates; HHS ASPE, "State and Local Estimates of the Uninsured Population Using the 2023 ACS."
Behind every percentage point in these rankings are real people facing difficult choices between getting care and paying rent. The following figures illustrate the human and financial consequences of uninsurance in America.
Note: All statistics in this section are drawn from peer-reviewed or government sources. CoverShield does not manufacture or alter any figures. Full citations available in the Methodology & Sources section below.
CoverShield connects Americans with licensed insurance agents in all 50 states. Compare plans from 40+ carriers in one free phone call — coverage often starts the same day. Whether you're in Texas, Florida, Georgia, or any other state, there are options available to you.
Free Quote — Visit covershield.liveAll uninsured rate figures in this report are drawn from the U.S. Census Bureau's American Community Survey (ACS) 2023 1-Year Estimates, Table S2701 ("Health Insurance Coverage Status"), which reflects the percentage of the total civilian noninstitutionalized population that lacked health insurance coverage at any time during 2023. State-level figures were cross-referenced with KFF State Health Facts and SHADAC (State Health Access Data Assistance Center) for consistency.
The national uninsured count of 25.3 million refers to the non-elderly (ages 0–64) uninsured population as published by HHS ASPE. Medicaid expansion status is as reported by KFF for calendar year 2023. The "partial" expansion designation (Georgia) reflects limited Medicaid waiver programs that do not provide full ACA-level coverage. North Carolina fully expanded Medicaid effective December 2023.
CoverShield's estimated $612/year savings figure represents the average difference between out-of-pocket spending for uninsured individuals and subsidized marketplace plan premiums for eligible consumers, based on CoverShield internal referral data and KFF Marketplace Subsidy Analysis. Individual results vary significantly based on income, location, age, and plan selection.
Primary Data Sources:
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