Percentage of population ≤64 years without health insurance

American Community Survey, U.S. Census Bureau. Calculated by the Dashboard Team using data from 2021, 5 year estimate.
Dashboard-City Average

Why do we measure the uninsured?

In 2016, 28.2 million Americans under age 65 lacked health insurance.People without health insurance may have limited access to health care, delay pursuing treatment, and experience poorer health compared to those with health insurance.2-4 Health insurance coverage increases preventive care use, such as breast and cervical cancer screenings and flu vaccinations.5 Health insurance coverage is also associated with increased labor force participation and higher incomes.3 Measuring the uninsured can also inform interventions aimed at increasing racial equity. Despite small gains in coverage, disparities persist in insurance coverage: People in lower income brackets are less likely than the general population to be insured.6-8

How do we measure the uninsured?

This metric includes persons, aged 0 through 64, who report having no current health insurance coverage.

Strengths and Limitations

Strengths of Metric

Limitations of Metric

• Health insurance coverage is fundamental to being able to access quality healthcare.

• Health care reform is currently a hotly debated political issue, and information about regional differences in health insurance coverage can help us understand how communities are affected.

• This metric is available broken down by race and ethnicity, which can help target resources and interventions for groups that historically have been underrepresented.

• Insurance plans vary in what health care procedures and services they cover.9

• Individuals often move in and out of health insurance coverage, so a measure of current insurance status may not adequately represent the uninsured population.6

• Race and ethnicity data are often collected using discrete options that may not account for all or multiple identities, leading to undercounting of those who are more likely to select “other.”


Uninsured is calculated by the following formula:

Uninsured Calculation

For more information on the calculation, please refer to the City Health Dashboard Technical Documentation.

Data Source

Estimates for this metric are from American Community Survey data using the S2701, B27001, C27001B-I tables. Multi-year data are available for this metric. For more information, please refer to Using Multi-Year Data: Tips and Cautions.


1. Centers for Disease Control and Prevention. National Center for Health Statistics: Health Insurance Coverage. Updated March May 16, 2023; https://www.cdc.gov/nchs/fastats/health-insurance.htm. Accessed June 15, 2023.

2. Shi L, Stevens GD. Vulnerability and unmet health care needs. The influence of multiple risk factors. J Gen Intern Med. 2005;20(2):148-154. doi:10.1111/j.1525-1497.2005.40136.x3.

3. Hadley J. Sicker and Poorer—The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income. Medical Care Research and Review. 2003;60(2_suppl):3S-75S.

4. McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. Milbank Q. 2009;87(2):443-494. doi:10.1111/j.1468-0009.2009.00564.x

5. Okoro CA, Dhingra SS, Li C. A triple play: psychological distress, physical comorbidities, and access and use of health services among U.S. adults with disabilities. Journal of health care for the poor and underserved. 2014;25(2):814-836.

6. DeNavas-Walt C, Proctor BD, Smith JC. US Census Bureau, Current population reports, P60-245, income, poverty, and health insurance coverage in the United States: 2012, US Government Printing Office, Washington, DC, 2013. In:2013.

7. Shane DM, Ayyagari P. Will health care reform reduce disparities in insurance coverage?: Evidence from the dependent coverage mandate. Medical care. 2014;52(6):528-534.

8. Sohn H. Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course. Popul Res Policy Rev. 2017;36(2):181-201. doi:10.1007/s11113-016-9416-y

9. Centers for Disease Control and Prevention. 500 Cities: Local Data for Better Health: Prevention. Updated December 12, 2016; https://www.cdc.gov/500cities/definitions/prevention.htm#ACCESS2. Accessed January 12, 2018.

Last updated: July 26, 2023