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19 of 20 US counties with lowest health insurance coverage located in Texas

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AUSTIN (KXAN) — A recent study found some individuals may be forgoing health insurance and instead making the tradeoff for their financial well-being.

SmartAsset, a financial technology company, said it ranked U.S. counties based on the rate of people under age 65 who were insured in 2024. Of the top 20, 19 counties with the least health insurance coverage were in Texas.


“In 2024, the average annual premium for a single individual was nearly $9,000 – and an estimated $25,500 for a family of four,” SmartAsset said.

According to the study, several Texas counties had the lowest health insurance coverage rates nationwide.

“More than any other county, 32.0% of residents in Hidalgo County don’t have health insurance,” SmartAsset said. “Cameron County (30.1% uninsured), Webb County (29.7%), Starr County (29.0%), Ector County (25.3%), Potter County (24.4%), Dallas County (24.2%), Harris County (23.8%) and El Paso County (23.5%) are also among the top 10 uninsured counties nationwide.”

The data showed one Texas county also had the lowest rate of primary care physicians.

According to the study, Orange County, Texas, ranked 84th overall for the lowest rate of health insurance, with 6,053 residents for every primary care physician. Smart Asset said that was more than any other county studywide.

Another Texas county also saw the largest drop in insurance coverage year over year, according to the study.

SmartAsset found Tom Green County, Texas, which was ranked as having the 25th highest number of uninsured residents, saw a drop from 17.5% uninsured in 2023 to 20.2% uninsured in 2024.

Top 20 counties with the highest rates of uninsured people

No. 1 – Hidalgo County, Texas

No. 2 – Cameron County, Texas

No. 3 – Webb County, Texas

No. 4 – Starr County, Texas

No. 5 – Ector County, Texas

No. 6 – Potter County, Texas

No. 7 – Dallas County, Texas

No. 8 – Harris County, Texas

No. 9 – El Paso County, Texas

No. 10 – Whitfield County, Georgia

No. 11 – Liberty County, Texas

No. 12 – Bastrop County, Texas

No. 13 – Jefferson County, Texas

No. 14 – Angelina County, Texas

No. 15 – Gregg County, Texas

No. 16 – Nacogdoches County, Texas

No. 17 – Henderson County, Texas

No. 18 – Smith County, Texas

No. 19 – Nueces County, Texas

No. 20 – Wise County, Texas