Nationally, 14.5 percent of adults aged 18 to 64 did not have health insurance in 2019, according to the National Center for Health Statistics. Texas is number one in the percentage of working-age adults without health insurance. Nearly one-third of Texans aged 18 to 64 does not have health insurance—more than double the national rate. In Oklahoma, one in four lacks health insurance. In Georgia and Florida, the figure is one in five. Why are these states doing so poorly? They have refused to expand Medicaid to all low-income adults (up to 138 percent of poverty level), as provided by the Affordable Care Act.
States with the largest percentage of adults aged 18 to 64 without health insurance
Texas: 30.5%
Oklahoma: 25.6%
Georgia: 22.3%
Florida: 20.6%
Arkansas and North Carolina tie for 5th place on the list of the worst, with 17.8 percent of working-age adults uninsured.
In states that have refused to expand Medicaid, an average of 20.8 percent of working-age adults do not have health insurance. In states that have expanded Medicaid, a much smaller 10.9 percent of adults aged 18 to 64 lack health insurance. The 17 states that had not expanded Medicaid as of 2019 were: Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin, and Wyoming.
Note: As of 2021, five additional states have adopted Medicaid expansion: Idaho, Missouri, Nebraska, Oklahoma, and Utah.
Source: National Center for Health Statistics, Geographic Variation in Health Insurance Coverage: United States, 2019 (PDF)
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