(WKYT) – Kentucky’s uninsured rate remained below the national median in 2024, but a stark divide between the state’s suburban and rural counties persists, according to new data released Wednesday by the U.S. Census Bureau.
The Small Area Health Insurance Estimates program, known as SAHIE, found that 8.1% of Kentuckians under age 65 — roughly 297,000 people — lacked health insurance in 2024. That figure sits below the national median county uninsured rate of 9.8%.
Nationally, the rate of uninsured individuals under 65 increased in 427 counties and decreased in 65 counties between 2023 and 2024. The median county uninsured rate climbed to 9.8% in 2024, up from 9.3% in 2023.
Rural Counties Drive the Gap
In Kentucky, 103 of the state’s 120 counties — 85.8% — recorded uninsured rates below 10%, a figure that far outpaces the national share of 41.4% of counties below that threshold.
But the data also reveal a persistent geographic divide.
Todd County, in south-central Kentucky, posted the state’s highest uninsured rate at 13.9%, followed by Casey County at 13.3%. Both are rural counties with limited economic resources. Fleming and Wolfe counties each recorded rates of 11.2%, while Monroe County came in at 10.8%.
Seventeen Kentucky counties in total exceeded the 10% threshold, most of them concentrated in Appalachian or south-central regions of the state.
Suburban Counties Lead the State
The lowest uninsured rates were concentrated in the Louisville and Northern Kentucky metro corridor.
Oldham County recorded the state’s best rate at 4.3%, followed by Boone County and Scott County, both at 5.4%, and Campbell County at 5.5%. Bullitt County rounded out the top five at 5.8%.
The gap between the best- and worst-performing counties — 9.6 percentage points — underscores the depth of the disparity.
Large Urban Counties Show Mixed Results
Kentucky’s two largest counties diverged on the metric.
Jefferson County, home to Louisville with a population of more than 641,000 under age 65, recorded a rate of 7.9% — below the state average. Fayette County, which includes Lexington, came in at 9.1%, above the state average.
Together, the two counties account for the largest share of the state’s approximately 297,000 uninsured residents in raw numbers.
Warren County, home to Bowling Green and the state’s fourth-largest county by population with more than 122,000 residents under 65, was the only large-population county to exceed the 10% threshold, recording a rate of 10.2%.
Context: A National Picture
SAHIE is the only source for single-year estimates of health insurance coverage at the county level for all 3,143 U.S. counties. The program provides statistics by sex, age group and income levels tied to thresholds for programs such as Medicaid.
Nationally, the share of counties with uninsured rates below 10% fell to 41.4% in 2024, down from 46.3% in 2023 and 45.2% in 2022. Uninsured rates among working-age adults ages 18 to 64 decreased in 73 counties and increased in 296 counties. Among children younger than 19, rates decreased in nine counties and increased in 185 counties.
The national median county uninsured rate among working-age adults living at or below 138% of the poverty threshold was 18.4% in 2024, compared with 17.7% in 2023.
This year’s release also marks the first time SAHIE has included a breakdown of health insurance estimates for adults ages 21 to 29.
The U.S. Census Bureau released the 2024 Small Area Health Insurance Estimates on Aug. 6, 2026. County-level data are available for all 3,143 U.S. counties.