Young adults and South Dakotans living below the poverty line were the most likely to be without health insurance in 2014, although the uninsured rate has dropped in recent years as the federal Affordable Care Act has required more people to purchase health insurance, according to recently updated federal data.
The state's overall uninsured rate was 11.4 percent in 2014, down from a recent high of 15.1 percent in 2009.
For health insurance coverage, South Dakota ranked 22nd among the 50 states, behind first-place Massechusetts at 3.8 percent and ahead of last-place Texas at 21.3 percent. The national rate for those under 65 was 13.5 percent percent in 2014, down from 17.7 percent in 2010.
For those under 18, South Dakota ranked 33rd at 5.7 percent, down from 8.4 percent in 2008. The national rate was 6 percent in 2014, down from 9.9 percent in 2008. Massachusetts ranked first in this category at 1.5 percent in 2014. Alaska was last, at 11.4 percent.
South Dakotans between the ages of 18 and 34 were almost twice as likely to be without health insurance, as the rate for being uninsured for them was almost 19 percent. They fared better than the poor, as South Dakotans living below poverty had a 26.1 percent rate of being uninsured, compared to a 9 percent rate for those living above poverty.
The rates of uninsured varied significantly between the state's two primary metropolitan areas. The rate of people without health insurance in the Rapid City metro area was close to double that of the Sioux Falls metro area in 2014.
The Rapid City metro area -- Pennington, Meade and Custer counties -- posted a rate of 13.2 percent in 2014 for those under 65, compared to 7.3 percent in the Sioux Falls metro area -- Minnehaha, Lincoln, McCook and Turner counties -- and 11.4 percent for South Dakota as a whole.
The rates of uninsured have dropped in both metro areas and across the state as a whole. The Rapid City metro rate has dropped from a recent high of of 18.2 percent in 2009; the Sioux Falls metro area dropped from a recent high of 11.6 percent in 2009; and the state rate is down from a recent high of 15.1 percent, also in 2009.
It's important to note that healthcare provided by the federal Indian Health Service is not counted as health insurance by the U.S. Census Bureau, the agency that collected the data. Residents of the city of Rapid City are 12.4 percent Native American, according to the U.S. Census, although a University of South Dakota researcher believes the true population is likely double that percentage. At the same time, Minnehaha County -- home to Sioux Falls -- records a Native American population at less than 3 percent. Other counties in the Sioux Falls metro area record Native American populations at less than 1 percent, while Meade and Custer counties record populations below 4 percent.