America's Uninsured Map Mirrors Its Electoral Map

Forty-two percent of America's uninsured live in just 10 states. These states share two things: they all voted for Donald Trump in 2024, and they all declined federal Medicaid expansion. The numbers create a stark divide. Non-expansion states average 12.1% uninsured. Expansion states average 6.7%. Texas alone has about 588,000 people in the coverage gap. They earn too much for Medicaid but too little for marketplace subsidies. These people need to find health insurance through alternative routes. 

This split reflects competing views on healthcare governance. One side prioritizes immediate coverage through federal expansion. Lower uninsured rates and economic benefits support this approach. The other side emphasizes long-term fiscal control and state autonomy. Critics fear federal funding won't last and costs will become unsustainable. The maps and data below show where these policy choices lead and what they mean for families and individuals caught in the gap.

The map below shows uninsured rates by state using 2024 ACS data. Hover over any state to see its uninsured rate, estimated uninsured count, expansion status and election outcome. The pattern is clear: Medicaid expansion correlates with lower uninsured rates across nearly every state.

MoneyGeek calculated population-weighted averages based on 2024 election results. States that voted Republican average 9.8% uninsured. States that voted Democratic average 6.0%.

Does this mean politics drives healthcare policy? The data shows both factors reinforce each other. States made expansion decisions based on fiscal philosophy and federal trust. These same priorities shape voting patterns. Health coverage now functions as both a policy debate and a political identifier.

Non-expansion states average 12.1% uninsured (11.6 million people) compared to 6.7% (16.2 million) in expansion states. The national uninsured total rose by about 1.0 million people from 2023 to 2024, pushing the rate from 7.9% to 8.2%. The South and Midwest experienced the sharpest increases after pandemic-era Medicaid protections expired.

The table below ranks all 50 states and Washington, D.C., by uninsured rate and shows how expansion status and election outcomes align across the country.

The divide sharpens when states are grouped by expansion status. Ten non-expansion states hold 28% of the U.S. population but account for 42% of the uninsured. The 41 expansion states and Washington, D.C., represent 72% of the population but only 58% of the uninsured.

States that haven't expanded Medicaid cite long-term cost concerns. Texas Lt. Gov. Dan Patrick told KERA in January 2025: "We are one of the states that didn't go along with that Medicaid expansion and thank goodness, because I wouldn't say we'd be bankrupt now but a lot of the states that did are in deep fiscal trouble."

A 2025 Paragon Health Institute survey found 58% of respondents agreed with this statement: "It's wrong for the federal government to pay so much more for able-bodied adults than traditional Medicaid recipients." Critics fear federal funding won't last. They believe states should control their own health policy decisions.

Wisconsin challenges the typical pattern. It hasn't expanded Medicaid but maintains a 5.3% uninsured rate. The state funds coverage for adults up to the poverty line. This approach reduces uninsured levels without federal expansion dollars, though it costs taxpayers more.

Nevada shows the opposite outcome. It expanded Medicaid but records an 11.4% uninsured rate, one of the nation's highest. Heavy reliance on service sector jobs, large immigrant populations with coverage barriers and rural access challenges drive the high rate.

North Carolina expanded Medicaid in late 2023, yet its uninsured rate sits at 8.6%. Expansion takes time to reach eligible residents. Active enrollment efforts continue.

These outliers prove expansion strongly predicts lower uninsured rates, but state economies and local policy choices matter too.

Enhanced federal subsidies expire December 31, 2025. CBO modeling projects premiums could double for many families once subsidies phase out. A family of four earning $75,000 could see premiums jump from about $460 monthly to $990—a $6,360 annual increase. Understanding average health insurance costs helps families and individuals prepare for changes ahead.

These premium increases will hit 22 million Americans. MoneyGeek's analysis of Americans without health coverage shows which families face the biggest jumps and what steps they can take before subsidies expire.

The impact won't hit all states equally. Families in non-expansion states already face limited options. Premium hikes will push many out of the market entirely. Expansion states will see higher costs too, but Medicaid offers a safety net that limits losses.

Will states revisit expansion when premiums spike? The coming year answers that question.

MoneyGeek used American Community Survey (ACS) 2023 and 2024 data from the U.S. Census Bureau to calculate state uninsured rates. We aligned these rates with 2024 Electoral College results to assess partisan differences.

Population-weighted averages were calculated using Census state population estimates to measure uninsured rates across expansion vs. non-expansion states and Republican vs. Democratic states.

Coverage gap estimates come from Kaiser Family Foundation. Expansion status reflects state policy as of October 2025, with North Carolina's December 2023 expansion included. Using ACS ensures year-to-year comparability, with national totals moving from 7.9% in 2023 to 8.2% in 2024.