GeraClinic / US health insurance coverage / Medicaid expansion comparison
Medicaid Expansion vs Non-Expansion: US Uninsured Rates
In 2024, the 10 US states that had not expanded Medicaid averaged 10.0% uninsured, compared with 6.9% across the 41 expansion states and DC — a 3.1 percentage-point gap. Averages are computed from official US Census Bureau ACS uninsured rates.
Do Medicaid-expansion states have lower uninsured rates than non-expansion states?
As of 2024, the 10 US states that had not expanded Medicaid averaged 10.0% uninsured, versus 6.9% across the 41 expansion states and DC — a 3.1 percentage-point gap — using real US Census Bureau ACS 1-year uninsured rates published September 2025.
The comparison takes every state's real ACS all-ages uninsured rate and groups it by the Census report's Medicaid-expansion footnote, then averages each group. This is a descriptive association computed from public data — not a controlled estimate of Medicaid's causal effect.
| Group | Average uninsured | Notes |
|---|---|---|
| Non-expansion states (10) | 10.0% | Had not expanded Medicaid as of 1 Jan 2024 |
| Expansion states + DC (41) | 6.9% | Expanded Medicaid |
| Difference | 3.1 pp | Non-expansion minus expansion |
| US national rate | 8.2% | All states, all ages |
Non-expansion states, by uninsured rate
| State | Uninsured (all ages) | Working-age 19–64 | Gera Coverage Index |
|---|---|---|---|
| Texas | 16.7% | 21.6% | 70 / 100 |
| Georgia | 12.0% | 16.5% | 50 / 100 |
| Florida | 10.9% | 15.5% | 47 / 100 |
| Wyoming | 10.3% | 14.2% | 45 / 100 |
| Mississippi | 9.7% | 14.2% | 41 / 100 |
| Tennessee | 9.7% | 13.6% | 41 / 100 |
| South Carolina | 9.0% | 13.1% | 38 / 100 |
| Kansas | 8.5% | 11.7% | 37 / 100 |
| Alabama | 8.2% | 12.3% | 35 / 100 |
| Wisconsin | 5.3% | 7.3% | 23 / 100 |
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Pick your state and age group to see the real ACS uninsured rate, how it compares nationally, and the Gera Coverage Index
Select your state to see its real latest ACS uninsured rate by age group, how it compares to the national rate, its rank, and the Gera Coverage Index.
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Medicaid expansion and uninsured rates: FAQs
- Do Medicaid-expansion states have lower uninsured rates?
- In 2024, the 10 states that had not expanded Medicaid as of 1 January 2024 averaged 10.0% uninsured (all ages), compared with 6.9% across the 41 expansion states and DC — a gap of 3.1 percentage points. These are simple averages of the real per-state ACS uninsured rates. Source: US Census Bureau ACS 1-year estimates; expansion status per the Census report.
- Which states had not expanded Medicaid as of 2024?
- Per the US Census report, the 10 non-expansion states (as of 1 January 2024) were: Texas, Georgia, Florida, Wyoming, Mississippi, Tennessee, South Carolina, Kansas, Alabama, Wisconsin. Among these, Texas had the highest all-ages uninsured rate at 16.7%. Source: US Census Bureau ACS 1-year estimates.
- Is the uninsured-rate difference caused only by Medicaid expansion?
- No. The averages on this page show an association, not a controlled cause: uninsured rates also reflect each state's population, economy and other policies. The 3.1 pp gap between non-expansion and expansion states is computed directly from real ACS rates and is presented as a descriptive comparison only.
Uninsured between coverage?
Whether or not your state expanded Medicaid, 8.2% of US residents were uninsured in 2024. GeraClinic offers affordable online consultations with a clinician — no insurance required.
Methodology
Each state is assigned to the “non-expansion” or “expansion” group using the US Census report's footnote identifying states that had not expanded Medicaid as of 1 January 2024 (Texas, Georgia, Florida, Wyoming, Mississippi, Tennessee, South Carolina, Kansas, Alabama, Wisconsin). The group averages are the simple (unweighted) means of those states' real ACS all-ages uninsured rates for 2024. This is a descriptive comparison of published figures, not a population-weighted or causal estimate, and nothing here is medical advice. Reference period: 2024 ACS 1-year estimates.
Source: US Census Bureau — Health Insurance Coverage by State: 2023 and 2024 (ACSBR-024, published September 2025), based on the 2023 and 2024 American Community Survey 1-year estimates. As a work of the US federal government this data is in the public domain. This directory is not affiliated with the US Census Bureau. Figures are for information only and are not medical advice.