About two-thirds of Americans get health insurance from private insurers, according to USA Facts. About 50% of insurance is covered by programs provided by their employers. Many other Americans get insurance from Medicare and Medicaid. And, millions of Americans have no health insurance at all. The Census put that number at 27.5 million in 2018.
These numbers have changed considerably over time, and the way they are counted is not always consistent. The share of Americans under the age of 65 without health insurance fell every year between 2010, when the Affordable Care Act was signed into law, and 2016, when President Barack Obama left office. Though the uninsured rate among Americans younger than 65 has inched up over the years since, it remains well below the 17%+ figures in the years leading up to the ACA. Some of this is due to the many people the COVID-19 pandemic has put out of work.
While most of those jobs have since been restored, the official 2020 uninsured rate for Americans under 65 will likely be higher than the 2019 rate, which, in some parts of the country, was already well above the national uninsured rate levels from before the passing of the ACA (Affordable Care Act).
Using data from the U.S. Census Bureau, 24/7 Tempo identified the ZIP with the worst health insurance coverage. ZIP codes were ranked based on the share of residents under age 65 — the age of eligibility for Medicare — who are uninsured.
Uninsured rates in the places we examined range from 43.2% to 75%. The largest share of ZIP codes with high rates are in the Midwest, including seven in Indiana and five in Ohio.
The ZIP code with the worst health insurance in America is 44627. Here are the details:
> Location: Fredericksburg, Ohio
> Residents under 65, no health insurance: 75.0%
> Residents under 65, Medicare coverage (or multiple types): 0.3% — 246th lowest of 19,556 zip codes
> Residents under 65, Medicaid coverage (or multiple types): 4.6% — 642nd lowest of 19,556 zip codes
> Residents under 65, VA coverage (or multiple types): 0.0% reported — 628th lowest of 19,556 zip codes
> Residents under 65, employer-based insurance (or multiple types): 15.7% — 45th lowest of 19,556 zip codes
> Residents under 65, direct-purchase insurance (or multiple types): 4.9% — 1,261st lowest of 19,556 zip codes
> Residents under 65, Tricare/military insurance (or many types): 0.0% reported — 1st lowest of 19,556 zip codes (tied)
Methodology: To determine the ZIP code with the worst health insurance coverage in the nation, 24/7 Tempo reviewed five-year estimates of the percentage of the noninstitutionalized civilian population under 65 without health insurance from the U.S. Census Bureau’s 2019 American Community Survey.
We used ZIP Code Tabulation Areas — a census geography type which defines areal representations of United States Postal Service ZIP codes (USPS ZIP codes do not define geographic boundaries but instead are a network of mail delivery routes in a service area). We refer to Census ZCTAs as ZIP codes.
Of the 33,120 ZIP codes the Census publishes data for, 32,989 had boundaries that fell within one of the 50 states or the District of Columbia.
ZIP codes were excluded if the noninstitutionalized civilian population under 65 was less than 1,000 or if the sampling error associated with a ZIP code’s data was deemed too high.
The sampling error was defined as too high if the coefficient of variation — a statistical assessment of how reliable an estimate is — for a ZIP code’s under 65 uninsured rate was above 15% and greater than two standard deviations above the mean CV for all ZIP codes’ under 65 uninsured rates. We similarly excluded ZIP codes that had a sampling error too high for their under 65 noninstitutionalized civilian population, using the same definition.
We selected the under 65 age group because Americans become eligible for Medicare at age 65, and the uninsured rate for the population above this age is less than 1% nationwide. However, because the Census doesn’t publish insurance coverage estimates specifically for the under 65 age group, we aggregated the data from more granular age breakdowns.
To ensure each aggregate estimate’s sampling error could be assessed using the definition above, we derived a margin of error for each aggregate estimate using the successive differences replication variance estimation methodology recommended and used by the U.S. Census Bureau.
The remaining 19,556 places were ranked based on their under 65 uninsured rates. To break ties, we used the number of insured people in the same population group.
The share of the population covered by each type of insurance — Medicare, Medicaid, VA, employer, direct-purchase, and Tricare/military — are for the same cohort and are also aggregated from five-year ACS estimates. The estimates reflect people who are covered by that type of insurance alone or in combination with other types on the list. So, when a person is covered by more than one type of insurance, they are included in each group.
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