The rate of Americans younger than 65 without health insurance decreased in 194 counties and increased in 85 others from 2022 to 2023. The U.S. Census Bureau last week released data for each of the nation’s 3,143 counties.

The county statistics are provided by sex and age groups and at income levels reflecting thresholds for state and federal assistance programs, such as Medicaid eligibility. State estimates also include health coverage by race and Hispanic origin.

Among the other highlights of the analysis:

  • 1,455 or (46.3%) of U.S. counties had an estimated uninsured rate below 10% in 2023, up from 45.2% of counties in 2022 and 39.2% in 2021.
  • The median county uninsured rate in 2023 was 9.3%, compared to 9.4% in 2022 and 10.4% in 2021.
  • Uninsured rates of working-age adults (ages 18 to 64) decreased in 182 counties and increased in 51 counties. Meanwhile, the uninsured rates of children (ages 0 to 18) decreased in 27 counties and increased in 89 counties.
  • Working-aged women had lower estimated uninsured rates than working-aged men in 62% of counties (1,950).
  • The median county uninsured rate of working-age adults living at or below 138% of poverty was 17.7%, down from 18.6% in 2022 and 20.3% in 2021.

The Census Bureau previously reported that 305.2 million (or 92%) of Americans had health insurance for all or part of 2023. Private health insurance (65.4%) continued to be more prevalent than public coverage (36.3%).

Of the subtypes of health insurance coverage, employment-based insurance was the most common, covering 53.7% of the population for some or all of the calendar year, followed by Medicaid (18.9%), Medicare (18.9%), direct-purchase coverage (10.2%), TRICARE (2.6%), and VA and CHAMPVA coverage (1.0%).

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