10 US Places With the Least Health Insurance Coverage — 9 Are in Texas

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Health insurance is a necessity in modern America, particularly with the skyrocketing cost of medical care and overall cost of living. Unfortunately, health insurance premiums are high, as well.

This creates a dilemma for individuals and families across America. Should they pay thousands of dollars per year for a service they hope to rarely use, or should they keep that money in their pockets and self-insure, accepting the risk of paying huge medical bills out of their own pocket — and potentially pay a penalty, as well? It’s a choice that everyone must make for themselves.

To determine which places in the United States have the least health insurance coverage, SmartAsset examined data from 810 U.S. counties to determine what percentage of residents under the age of 65 were insured in 2024. Of the top 10 counties, 9 were in Texas, a statistic that seems like an aberration. However, there are a number of factors that may help account for this.

First, Texas is a state in which there is no longer a penalty for not having health insurance. Second, Texas has a large population of residents with incomes below the poverty level. This could make health insurance unaffordable, according to the Texas Medical Association.

Regardless of the reason, Texas does rank poorly in terms of the SmartAsset study, but it’s not alone. Here’s a look at the 10 counties in the U.S. with the least health insurance coverage.

Hidalgo County, Texas

• People under 65 who are uninsured: 32.05%
• Children under 19 who are uninsured: 12.57%

Cameron County, Texas

• People under 65 who are uninsured: 30.08%
• Children under 19 who are uninsured: 13.65%

Webb County, Texas

• People under 65 who are uninsured: 29.69%
• Children under 19 who are uninsured: 12.28%

Starr County, Texas

• People under 65 who are uninsured: 29.00%
• Children under 19 who are uninsured: 12.46%

Ector County, Texas

• People under 65 who are uninsured: 25.26%
• Children under 19 who are uninsured: 18.56%

Potter County, Texas

• People under 65 who are uninsured: 24.44%
• Children under 19 who are uninsured: 13.36%

Dallas County, Texas

• People under 65 who are uninsured: 24.15%
• Children under 19 who are uninsured: 14.88%

Harris County, Texas

• People under 65 who are uninsured: 23.76%
• Children under 19 who are uninsured: 13.93%

El Paso County, Texas

• People under 65 who are uninsured: 23.52%
• Children under 19 who are uninsured: 10.09%

Whitfield County, Georgia

• People under 65 who are uninsured: 23.43%
• Children under 19 who are uninsured: 10.12%

The Bottom Line

From the SmartAsset data, it seems as if Texas has a near-monopoly on counties with a low percentage of healthcare coverage. But it’s not coincidental that each of the 10 counties on this list, including the nine from Texas, all have poverty levels above the national average.

In fact, in some counties, including Hidalgo County, the poverty level is more than double the national average of 12.5%, according to data from the U.S. Census Bureau and Data USA. Residents in these high-poverty counties likely want healthcare coverage for themselves and their families but simply cannot afford it.

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