States ranked by percentage of uninsured residents in 2020

The Commonwealth Fund released its "2022 Scorecard on State Health System Performance" on June 16 to examine how well each state's healthcare system performed during the COVID-19 pandemic. The analysis included health insurance coverage rates in each state in 2020.

Uninsured rates nationwide were mostly unchanged in 2020 because of the ACA and federal relief. States that did not expand Medicaid reported the highest uninsured rates. The national average was 12.4 percent.

Though federal data does show a decline in uninsured rates in early 2021, they may go back up in the following few years. The temporary "continuous eligibility" Medicaid requirement ends when the federal public health emergency does, leading to as many as 15.8 million people losing Medicaid coverage. Furthermore, the American Rescue Plan Act's premium tax credits for ACA plans will expire at the end of this year without a congressional extension. Without an extension, up to 3 million people could lose coverage.

States ranked by uninsured rates in 2020, which includes ties:

1. Texas: 23.6 percent
2. Oklahoma: 21.7 percent
3. Georgia: 18.7 percent
4. Florida: 18.3 percent
5. Mississippi: 17.4 percent
6. Wyoming: 16.4 percent
7. Nevada: 16.1 percent
8. North Carolina: 15.7 percent
9. Alaska: 15.5 percent
   South Carolina: 15.5 percent

11. Arizona: 15.4 percent
12. Alabama: 15 percent
13. Tennessee: 14.6 percent
14. Missouri: 14.3 percent
15. South Dakota: 14.2 percent
16. Idaho: 13.7 percent
    New Mexico: 13.7 percent

18. Kansas: 13.3 percent
19. Arkansas: 12.7 percent
20. Louisiana: 12 percent
21. Montana: 11.8 percent
22. Nebraska: 11.4 percent
23. Colorado: 11.3 percent
24. Maine: 10.8 percent
    Utah: 10.8 percent

26. West Virginia: 10.6 percent
27. New Jersey: 10.5 percent
28. Illinois: 10.4 percent
29. Virginia: 10.1 percent
30. California: 10 percent
31. Indiana: 9.9 percent
32. Delaware: 9.5 percent
33. Oregon: 9.4 percent
34. Ohio: 9.3 percent
35. Washington: 9.2 percent
36. North Dakota: 9 percent
37. New Hampshire: 8.9 percent
38. Pennsylvania: 8.2 percent
39. Kentucky: 8 percent
    Maryland: 8 percent

41. Michigan: 7.8 percent
42. Wisconsin: 7.6 percent
43. New York: 7.4 percent
44. Iowa: 7.2 percent
45. Minnesota: 6.9 percent
46. Vermont: 6.5 percent
47. Connecticut: 6.4 percent
48. Hawaii: 5.4 percent
49. Rhode Island: 5 percent
50. District of Columbia: 4.3 percent
51. Massachusetts: 3.6 percent