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Health Insurance Coverage: Uninsurance by Metro Areas in 2017 (Interactive)November 16, 2018:
An estimated 8.7% of the U.S. population remains without health insurance coverage, even in a post-Affordable Care Act (ACA) landscape. Data from the 2017 American Community Survey (ACS) show that many of the remaining uninsured are clustered in metropolitan areas—identified as metropolitan statistical areas (MSAs) by the U.S. Census Bureau—because these areas are, by definition, more densely populated. The visualization of uninsurance by MSA in the map above illustrates geographic concentrations of the uninsured by count (circle size) and rate (circle color), and helps us understand regional patterns in uninsurance and where enrollment efforts might best be targeted to help the remaining uninsured gain coverage. Hover over any MSA in the map above to see its concentration of uninsurance.
Counts of Uninsured: Where Do the Most Uninsured Live?
Regardless of their uninsurance rates, larger MSAs tend to have larger numbers of uninsured residents due to their size. Even large MSAs with comparatively modest rates of uninsurance have large counts of uninsured relative to smaller MSAs. The MSAs with the largest counts of uninsured are all among the 10 largest MSAs in the country and include the following:
|Top Five MSAs by Count of Uninsured, 2017|
|MSA||Count Uninsured||Percent Uninsured||MSA Rank by Population|
|1. New York-Newark-Jersey City, NY-NJ-PA||1.41 million||7.0%||1|
|2. Houston-The Woodlands-Sugar Land, TX||1.24 million||18.2%||5|
|3. Dallas-Fort Worth-Arlington, TX||1.21 million||16.5%||4|
|4. Los Angeles-Long Beach-Anaheim, CA||1.14 million||8.6%||2|
|5. Miami-Fort Lauderdale-West Plam, FL||950,000||15.5%||7|
Conversely, a relatively small MSA with a high rate of uninsurance can contain a substantially larger number of uninsured individuals than a larger MSA with a lower rate of uninsurance. The MSA with the highest rate of uninsurance is the 68th-largest MSA of McAllen-Edinburg-Mission, TX, where 30.0% of the population is uninsured, representing 255,000 people. In contrast, the 10th-largest MSA of Boston-Cambridge-Newton, MA-NH, has an uninsurance rate of only 3.0%, representing just 144,000 people.
Rates of Uninsured
There are interesting regional patterns in the MSAs with the highest and lowest rates of uninsurance. As shown in the table below, the MSAs with the lowest rates of uninsurance are located in the northeast and north-central U.S., whereas the MSAs with the highest rates of uninsurance are located in Texas, particularly along the southern border.
Among the five MSAs with the lowest uninsurance rates, four are located in Massachusetts, a state that implemented state-level coverage expansions before the ACA and had the lowest state-level rate of uninsurance in 2017 at 2.8%. The five lowest rates of MSA-level uninsurance range from 2.1% in the Pittsfield, MA MSA to 3.0% in the Boston-Cambridge-Newton, MA MSA.
Among the five MSAs with the highest uninsurance rates, all are located in Texas, and all except Odessa are located along the border. In contrast to Massachusetts, Texas has not implemented a Medicaid expansion and had the highest state-level rate of uninsurance in 2017 at 17.3%. The five highest rates of MSA-level uninsurance range from 20.6% in the El Paso, TX MSA to 30.0% in the McAllen-Edinburg-Mission, TX MSA.
|Highest and Lowest Uninsured Rates by MSA, 2017|
|MSAs with Lowest Uninsured Rates||Uninsured Rate||MSAs with Highest Uninsured Rates||Uninsured Rate|
|1. Pittsfield, MA||2.1%||1. McAllen-Edinburg-Mission, TX||30.0%|
|2. Springfield, MA||2.6%||2. Laredo, TX||28.9%|
|3. Ann Arbor, MI||2.7%||3. Brownsville-Harlingen, TX||27.6%|
|4. Worcester, MA||2.9%||4. Odessa, TX||21.1%|
|5. Boston-Cambridge-Newton, MA||3.0%||5. El Paso, TX||20.6%|
More about Metropolitan Statistical Areas
According to the U.S. Census Bureau, a metropolitan statistical area, or MSA, refers to a “core area containing a substantial population nucleus, together with adjacent communities having a high degree of economic and social integration with that core.” At least one urban area with a population of 50,000 or more must be included in every MSA. When an MSA is made up of multiple urban areas, the city with highest percentage of resident population is designated a “principal city.” If there are multiple principal cities (an MSA may have up to three), then the city with the largest population is listed first in the MSA title (for example, Boston is listed first in the Boston-Cambridge-Newton MSA).
An MSA with a principal city population of 2.5 million or more can be subdivided if certain other criteria are met, but thus far the only three qualifying cities in the United States—New York, Los Angeles, and Chicago—remain undivided. According to the latest polling data from September 2018, there are currently 384 metropolitan statistical areas in the United States and Puerto Rico.
State Health Compare allows users to dig deeper into data regarding a variety of health insurance coverage types (including uninsured, insured, private, public, employer-sponsored, individual, Medicaid/CHIP, and Medicare). Our site provides state-level estimates from 2008 to 2017 with breakdowns by age, race/ethnicity, poverty level, family income, education and more. State Health Compare also features state-level data on more than 40 additional measures from 13 data sources. State Health Compare allows users to compare states, examine trends over time, and download data visualizations such as 50-state maps, bar charts, and tables.
All data presented in this post come from SHADAC’s analysis of the 2017 American Community Survey (ACS).
 U.S. Census Bureau. “Metropolitan and Micropolitan.” Retrieved October 31, 2018, from https://www.census.gov/programs-surveys/metro-micro/about.html