Health Insurance Coverage
States refusing Medicaid expansion contributed to a 15% uninsured rate for working-age Southerners compared to 11% outside the South.
Lack of health insurance coverage by county, 2016-20
Population age 19-64
Source: Census Bureau’s American Community Survey 2016-20 and Kaiser Family Foundation. Note: WI has partially expanded Medicaid (under a Medicaid waiver) to include all adults under 100 percent federal poverty level.
Seven states in the deep South (MS, AL, GA, FL, SC, NC, and TN) have not adopted Medicaid expansion. As a result, according to the most recent data (2016-2020), 15% of working-age Southerners lack health insurance compared to 11% in the rest of the United States. The highest uninsured rate is in Texas — another state that has not expanded Medicaid — at 23%. States with the next highest rates of the uninsured working-age population were Oklahoma at 21%, Florida at 19%, and Georgia and Mississippi at 18%. In comparison, only 4% in MA were without coverage.
Lack of health insurance coverage is particularly common in rural counties in the South. Looking at Southern counties with particularly high rates of uninsurance (15% or more of all working-age adults lacking health insurance), ⅔ of these counties were completely or mostly rural. The implications of not expanding Medicaid are severe for rural communities. Without Medicaid expansion, hospitals don’t receive sufficient reimbursement for the care they provide to an increased number of uninsured patients and, as a result, oftentimes must close for financial reasons. Lack of health insurance also means many people incur medical debt. By December 2020, credit bureau data revealed that about 20% of Southerners had medical debt compared to 13% for non-Southerners (Medical Debt). States that expanded Medicaid by 2014 saw a greater decline in medical debt among their residents than did states that failed to expand Medicaid.1
“Medical Debt in the US, 2009-2020”. Kluender, Mahoney, Wong, et al. JAMA Network. July, 2021. https://jamanetwork.com/journals/jama/fullarticle/2782187