People Without Health Insurance measures the percentage of residents who lack any form of public or private health coverage, based on estimates from the U.S. Census Bureau’s American Community Survey. Because health insurance is one of the strongest predictors of access to primary care, preventive services, and timely treatment, this indicator highlights populations most at risk for unmanaged chronic disease, medical debt, and avoidable emergency room use. Tracking uninsured rates helps communities identify gaps in coverage, understand how economic shifts and policy changes affect families’ ability to afford care, and target outreach efforts for Medicaid enrollment, marketplace plans, and local safety-net programs.

Why Does this Matter?

1. Lack of insurance is a significant barrier to getting needed care

• Uninsured adults are far more likely to delay or forgo needed medical care, prescription drugs, and preventive services than those with coverage, even after accounting for income and health status. High local uninsured rates signal where residents are most likely to go without routine care until problems become emergencies.¹

2. Being uninsured is linked to worse health outcomes and higher mortality

• Studies show that uninsured adults have higher risks of avoidable hospitalizations, later-stage cancer diagnoses, and elevated mortality compared with similar insured adults. Communities with more uninsured residents are therefore at greater risk for preventable illness and early death.²

3. Expanding coverage improves financial stability and reduces uncompensated care

After major coverage expansions, such as the Affordable Care Act and state Medicaid expansions, hospitals saw significant declines in uncompensated care, and patients saw reduced medical debt and catastrophic out-of-pocket spending. Tracking uninsured rates helps local leaders understand where connecting people to coverage could reduce financial strain on families, providers, and public budgets.³

1.  Institute of Medicine. (2009). America’s uninsured crisis: Consequences for health and health care. National Academies Press. Accessed December 2025. https://pubmed.ncbi.nlm.nih.gov/25009923/
2. Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). Health insurance and mortality in U.S. adults. American Journal of Public Health, 99(12), 2289–2295. https://doi.org/10.2105/AJPH.2008.157685
3.  Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2018). The effect of the Patient Protection and Affordable Care Act Medicaid expansions on financial well-being. Journal of Public Economics, 163, 99–112. https://doi.org/10.1016/j.jpubeco.2018.04.009