Why do we measure the uninsured?

In 2020, 31.2 million Americans under the age of 65 lacked health insurance.(1) 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) In particular, health insurance coverage increases primary 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) Finally, disparities persist in insurance coverage: certain racial/ethnic groups and 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 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 provides disaggregated estimates by age group (children aged 0-17 and adults aged 18- 64), in addition to race/ethnicity and gender.

Insurance plans vary in what health care procedures and services they cover, so this measure of uninsurance does not capture those who might be underinsured or lack a quality insurance plan .

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)


Uninsured is calculated by the following formula:

uninsured calculation

This metric was calculated by aggregating estimates from smaller geographies to the congressional district level. For more information on the calculation, please refer to the Congressional District Health Dashboard Technical Document.

Data Source

Estimates for this metric are from American Community Survey data using the S2701, B27001, C27001B-I tables.

Years of Collection

Calculated by the Dashboard Team using data from 2021, 5 year estimate


  1. Centers for Disease Control and Prevention. National Center for Health Statistics: Demographic Variation in Health Insurance Coverage: United States, 2020. National Health Statistics Report. Issue Number 169, February 11, 2022; https://www.cdc.gov/nchs/data/nhsr/nhsr169.pdf. Accessed November 17, 2022.

  2. Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Annals of internal medicine. 1991;114(4):325-331.

  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. Baker  DW, Sudano  JJ, Albert  JM, Borawski  EA, Dor  A. Lack of Health Insurance and Decline in Overall Health in Late Middle Age. New England Journal of Medicine. 2001;345(15):1106-1112.

  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. Escarce JJ, Goodell S. Racial and ethnic disparities in access to and quality of health care. The Synthesis project Research synthesis report. 2007(12).

Last updated: February 20, 2024