2021 ACS Data: State and County Uninsured Rates, with Comparison Year 2019
Each year, SHADAC uses data released from the American Community Survey (ACS) via the U.S. Census Bureau's data.census.gov tool to produce estimates of uninsurance at the state and county level.*
Click on a state in the interactive map below to view a PDF table of uninsured rates by state and sub-state geographies, but also by demographic characteristics (e.g., age, race/ethnicity, and poverty level) for 2021 and comparison year 2019.^
Note: These tables present uninsured rates, which indicate the share of the population that is uninsured. For example, a 10 percent uninsured rate for adult women indicates that 10 percent of all adult women are uninsured.
Additional Estimates (50-State Comparisons)
Maps & Tables of Private, Public, & Uninsured Changes from 2019 to 2021
Private Coverage Rates by State, Change from 2019 to 2021, for All People
Public Coverage Rates by State, Change from 2019 to 2021, for All People
Uninsurance Rates by State, Change from 2019 to 2021, for All People
Uninsurance Rates by State, Change from 2019 to 2021, for Children under age 18
About the ACS
The ACS is a household survey that began in 2005 and produces annually updated data on a variety of population characteristics, including health insurance coverage. In total, the ACS surveys approximately three million U.S. households each year. An important feature of the ACS is that it includes a large enough sample for state‐level and sub‐state estimates.
The ACS began asking survey respondents about health insurance coverage during the 2008 calendar year. Specifically, the survey asks respondents about current coverage for each person in the respondent’s household. A person is categorized as “insured” if he or she has coverage at the point in time at which the survey is administered.
*Why Aren’t Estimates Provided for All Counties?
Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
^Why Are the Estimates Being Compared to 2019 and not to 2020?
Impacts of the COVID-19 pandemic on survey data collection and dissemination efforts, as well as the presence of measurable nonresponse bias, resulted in ACS estimates from data year 2020 being released on an “experimental only” basis, and the Census Bureau has recommended that these estimates not be used or compared to any other data year.
How Are These Estimates Different from the Estimates that SHADAC Publishes Using Census Bureau Micro-Data Files?
Two definitions used by the Census Bureau to generate the tabulations above differ from those that SHADAC uses to generate tabulations for State Health Compare. The definitional differences are as follows:
The Census Bureau defines a family as “all related people in a household.”
SHADAC defines a family using a measure called the “Health Insurance Unit” (HIU), which includes all individuals who would likely be considered a family unit in determining eligibility for either private or public coverage.
To learn more about the 2020 update of SHADAC's Health Insurance Unit (HIU) see our HIU resource page, which houses two issue briefs: The first describes the SHADAC HIU, its purpose, the most recent update, and improvements to HIU data inputs; and the second outlines the impacts of using the SHADAC HIU in analysis so that researchers can assess whether the SHADAC HIU is suitable for their research and what the potential impacts of its use might be. The page also provides a link to STATA and SAS codes to aid in the use of the HIU variable.
The Census Bureau determines family income as a percentage of the Federal Poverty Level (FPL), which is a definition of poverty used primarily for statistical purposes. For example, FPL is used to estimate the number of Americans living in poverty each year.
SHADAC determines family income as a percentage of the U.S. Department of Health and Human Services’ Federal Poverty Guideline (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
Check out our blog post from May 2022 to learn more about the difference between FPL and FPG,
Related ACS Materials: