These States Have the Most Uninsured Americans. Tax Reform Could Make Things Worse.

One of the biggest tax reform changes is the repeal of the individual mandate for health insurance. The Congressional Budget Office predicts the repeal would save the federal government $338 billion between 2018 and 2027, thanks to lower federal costs for premium tax credits and Medicaid. Surely, these savings should amount to great news for Americans on both sides of the debate. But it also notes that as many as 13 million more Americans could be left uninsured — either by choice or due to a lack of affordability — because of the removal of the mandate.

Some think that Medicare and Medicaid will become the primary targets for adjustments in the effort to reduce the Federal Deficit. Many predict that changes in things like eligibility age increases for these programs, caps on spending per beneficiary, and increases in cost-sharing would be the first under the microscope. Others worry careless adjustments like these could make our healthcare situation much worse.

How might tax reform affect uninsured rates?

Recent tax reforms could make health insurance a lot trickier. | Scott Olson/Getty Images

It’s no secret that most Americans would like to see the government be a bit stingier with its spending, but some warn that cuts could be damaging to the country’s overall health. After all, there’s a strong link between health insurance coverage and actual health. One study even found correlations between financial health and insurance. Those who had Medicaid saw a decrease in the number of medical bills sent to collection and an elimination of costly out-of-pocket expenses.

The fact is that a large portion of Americans remain uninsured. According to the annual health report from United Health Foundation, over 10% of the population in many states lack coverage. Commonwealth Fund warns that the uninsured rate could climb even higher if healthy people exit the markets. This would leave a sicker, more costly insurance pool behind. Others suggest the mandate’s removal would make for a more competitive free market system across state-lines and cause costs to decrease.

It’s unclear whether tax reform will spike or sink uninsured rates state-wide. But what is clear is that too many people remain uninsured today. Where do most uninsured Americans call home? Here are the 15 states with a severe lack of health insurance coverage.

15. Montana

Montana, USA

A lot of people in Big Sky Country lack health insurance. | PStieger/iStock/Getty Images

  • Percentage of uninsured population: 9.9%

The United Health Foundation says the U.S. average of uninsured Americans is over 9%. Unfortunately, all states on this list have rates higher than the national average, and Montana is no different. In Big Sky Country, 9.9% of Montana’s population has difficulty accessing the health care system and could have unmet health needs as a result.

Next: An unfortunate added cost of no insurance

14. New Mexico

Taos, New Mexico

The rate of uninsured people in New Mexico could rise in the future. | RoschetzkyIstockPhoto/iStock/Getty Images

  • Percentage of uninsured population: 10.1%

UHF says that a lack of health insurance could lead to emergency visits that can be 10 times costlier than treatment in a clinic. About 10.1% of residents in New Mexico are uninsured. With tax reform changes on the horizon, it’s likely that number could fluctuate drastically in the coming years.

Next: A state that could face higher premiums very soon

13. Arizona

Mesa, Arizona

Arizona seniors could feel the pinch from the latest tax reforms. | RobertSilberblatt/iStock/Getty Images

  • Percentage of uninsured population: 10.4%

New Mexico’s western neighbor, Arizona, also boasts a high number of people without health insurance. Commonwealth Fund notes that Arizona is one of the states where they expect seniors over 60 to pay more in annual premiums payments for their own coverage in 2019.

When comparing projected tax cuts to 2018 premium increases, they found only some Americans would have those increases offset by tax cuts. Their predictions suggest annual payments could rise to $1,469 for the unlucky residents in Arizona.

Next: High uninsured rates in South Carolina

12. South Carolina

Columbia, South Carolina, USA

South Carolina’s citizens could be hit with higher insurance premiums in the next few years. | Sean Pavone/iStock/Getty Images

  • Percentage of uninsured population: 10.5%

South Carolina has nearly 10.5% of its population uninsured, meaning many these folks were subject to the individual mandate penalty. For 2017, that penalty amounted to 2.5% of household income or a person rate with a maximum of $2,085 (you pay whichever is highest.)

With the repeal, uninsured Americans would be free of the costly fine moving forward, but many still worry about getting hit with higher premiums instead. So whether tax reform increases or decreases the uninsured rate among people remains to be seen.

Next: A healthy state with lots of insurance gaps

11. Idaho

Welcome sign on the boarder to Idaho State

Some people in Idaho already have a hard time affording health care. | oscity/iStock/Getty Images

  • Percentage of uninsured population: 10.6%

Idaho usually falls above average in their overall health ratings published by UHF. So it could be the 10.6% of the uninsured population are hedging their bets when it comes to healthcare coverage. For a select few, the uninsured penalty could be lower than their projected health care costs anyway. For others, affording health care of any kind just isn’t possible, and they’re hoping tax reform doesn’t make it any harder.

Next: The 10th-highest population of uninsured Americans

10. North Carolina

Charlotte, North Carolina, USA

North Carolina is making some progress on insuring its citizens, but it’s still below the national average. | Sean Pavone/iStock/Getty Images

  • Percentage of uninsured population: 10.8%

North Carolina has the tenth-largest population of uninsured Americans in the country — although the Census Bureau says this percentage is a record low for the state. 10.8% of North Carolinians are without health insurance. They’re also falling behind in overall health rankings, according to the UHF report, receiving dismal scores for clinical care metrics statewide.

Next: One of the many Southern states with too many without health insurance

9. Louisiana

Louisiana has some work to do when it comes to health care. | Mario Tama/Getty Images

  • Percentage of uninsured population: 11.1%

Louisiana is a historically unhealthy state, which is only cemented by a higher-than-average number of residents living without health insurance. It has over 11% of the population listed as uninsured. And as you’ll see moving forward, they’re not the only Southern state with high uninsured rates.

Next: Annual premiums could increase in this state

8. Wyoming

Jackson, Wyoming

Wyoming is in danger of seeing insurance premiums rise. | Town of Jackson via Facebook

  • Percentage of uninsured population: 11.5%

Wyoming is another state Commonwealth Fund believes could face higher annual premium rates after tax reform modifications. They suggest repealing the individual mandate would hike premium payments to $1,783, an additional $689 per year by 2019. Today, a whopping 11.5% of Wyoming’s population is uninsured.

Next: Another Western state

7. Nevada

view of las vegas

Health care is already expensive in Nevada. It could get worse. | Ethan Miller/Getty Images for Ascaya

  • Percentage of uninsured population: 11.9%

Most people would prefer the peace of mind that comes with health insurance should something unexpected happen. Unfortunately, nearly 12% of Nevada’s population is without that assurance. Could it be many families are opting to pay a lesser penalty rather than splurge for costly health insurance? Maybe. But it could also be health insurance premiums are way too expensive as it stands and they’re waiting to see how future reform affects their rates. Needless to say, a large chunk of the population is hoping healthcare doesn’t get any worse come D-day.

Next: A state brimming with uninsured Americans

6. Mississippi

Welcome to Mississippi

Mississippi has a high population of uninsured Americans. | Meinzahn/iStock/Getty Images

  • Percentage of uninsured population: 12.3%

Mississippi currently has 12.3% of its population in an uninsured status. A WalletHub state-by-state analysis suggests states like North Dakota and Ohio will experience significant potential job loss due to tax credit repeal and Medicaid expansion brought on by reform in 2019. The good news is that Mississippi is not thought to be one of those states that could experience job loss. In fact, WalletHub thinks they’ll see some of the fewest job losses in the country.

Next: A problem for seniors in Florida

5. Florida

Amelia island

Despite a high population of seniors, a lot of Florida residents remain uninsured. | dawnamoore/iStock/Getty Images

  • Percentage of uninsured population: 12.9%

Florida’s population of uninsured Americans reaches nearly 13%. Given the fact the Sunshine State also houses one of the largest senior populations, it’s safe to assume many older Americans are living without necessary insurance in this state. The UHF report says Florida has made the biggest improvement in health metrics year-over-year. Hopefully, this will help get more residents the care they need.

Next: Another Southern state

4. Georgia

Riverwalk in Augusta Georgia

Georgia is a beautiful state, but its uninsured population is alarming. | SeanPavonePhoto/iStock/Getty Images

  • Percentage of uninsured population: 13.4%

The fourth-highest population of uninsured Americans is in Georgia. Like many of its Southern neighbors, more residents than we wish to believe have little to no access to the health care system and influential preventative programs in this state.

Next: A historically unhealthy state

3. Oklahoma

Oklahoma City area on a map

Tax reform could lead to even more uninsured Oklahomans. |

  • Percentage of uninsured population: 13.9%

Oklahoma is also a state that falls consistently below average for overall health. Considering that 13.9% of the population is uninsured, its lowly health rating is not too surprising. Many are worried that tax reform could spike this uninsured rate even higher, but time will tell just how much these new plans would affect this state.

Next: Believe it or not, there’s a glimmer of hope for this state

2. Alaska

U.S. Fish and Wildlife Service

Health care is already too much for many Alaskans. | U.S. Fish and Wildlife Service/Getty Images

  • Percentage of uninsured population: 14.5%

Healthcare is expensive in Alaska. But it’s also a state WalletHub believes would benefit positively from the Affordable Care Act repeal. When they compared the growth of uncompensated care costs by 2021, Alaska ranked last of all 50 states. Such low growth in this costly category is a glimmer of hope for the 14.5% of uninsured Americans currently living in the Frontier State.

Next: The state with the most uninsured Americans is…

1. Texas

Frisco, Texas

Texas already has the highest rate of uninsured citizens. | Jaynir/iStock/Getty Images

  • Percentage of uninsured population: 16.9%

The number one state that houses the most uninsured Americans is Texas. The Lone Star State is one of the most populated states in America. So, when 16.9% of Texans are listed as uninsured, it means that a sizable number of people are living without important healthcare services. Hopefully the coming reform helps shrink this number, but few are optimistic that it will.

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