Stats Shot: Which States Have the Most Residents Without Health Insurance?

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Connecting state and local government leaders

New U.S. Census Bureau figures offer insight into how coverage levels in each of the 50 states have changed since the implementation of Obamacare.

This is the next installment in Stats Shot, a semi-regular series of posts looking at the statistics that shape state, county and municipal governments and the communities they serve across the United States.

Among U.S. states, Texas had the highest percentage and greatest number of people without health insurance coverage in 2014, according to new U.S. Census Bureau data released on Wednesday.

Of the roughly 25.9 million people in the Lone Star State, 19.1 percent, or just over 5 million, lacked health insurance last year, according to Census Bureau estimates.

On the other end of the spectrum was Massachusetts, a state that enacted sweeping health care reforms nearly a decade ago. There only 3.3 percent, or about 219,000 of the approximately 6.6 million people in the state, didn't have coverage.

In Texas, uninsured rates hovered between 21 and 26 percent between 1999 and 2012, past Census figures show. And, according to the new estimates, the percent of people without health insurance there did decline by about 3.1 percent last year compared to 2013.

Wednesday was the first time the Census Bureau has issued these types of health insurance figures since many key provisions of the Affordable Care Act, sometimes referred to as Obamacare, went into effect in 2014.

The map below shows some of the data the Census Bureau published for each state.

Scrolling over a state displays the estimated percent of its population that was uninsured in 2013 and 2014, as well as how that figure changed over the course of those two years. While the percent change figures vary widely from place-to-place, the proportion of people who did not have health insurance went down in every state and the District of Columbia from 2013 to 2014. Also displayed in the map is the total number of uninsured individuals for each year.

The darker a state, the larger the percent of its population that was uninsured in 2014.

Nationwide, 11.7 percent of people remained uninsured in 2014, according to Census Bureau estimates. This marks a 2.8 percent decrease from 2013. The drop is significant compared to the preceding years when the uninsured rate remained relatively stable and above 2013 levels.

The chart below ranks states based on the declines they saw in the percentage of people without insurance from 2013 to 2014.

In Kentucky, which topped the list, the percent of uninsured people fell by 5.8 percent to around 366,000 people in 2014. 

Kentucky is among the states that expanded Medicaid under the Affordable Care Act, and also launched its own online health insurance marketplace.

Under the Affordable Care Act, states can choose to expand their Medicaid programs to cover adults earning up to 138 percent of the federal poverty level, which is currently $16,242 annually for an individual. The federal government has committed to paying the expansion costs through 2016. After that, the federal share of the expenses will gradually decline until it reaches 90 percent in 2020. As the federal payments go down, states that decided to expand Medicaid will be left to pay the difference.

Critics argue that the expenses tied to the expansion could become burdensome for states, and Medicaid has remained an issue in Kentucky's current gubernatorial race.

This final chart shows the total number of uninsured people in each state during 2014, with Texas on top, followed by the nation's most populous state, California.

The Census Bureau issued the healthcare figures as part of a broader package of data, which also included information about income and poverty. The full release can be found here.

Bill Lucia is a Reporter for Government Executive's Route Fifty.

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