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WASHINGTON - About one Arizonan in five lacked health insurance in 2011, and the number rose to almost one in four in some counties, according to the most recent Census Bureau estimates.

Statewide, 19.6 percent of people under age 65 were uninsured, compared to a national rate of 17.3 percent, according to the Census Bureau's Small Area Health Insurance Estimates, which said Arizona had the 13th-highest rate of uninsured.

Within the state, results varied widely, ranging from a low of 14.4 percent uninsured in Greenlee County to highs of 26.2 percent in both La Paz and Santa Cruz counties.

About half the counties saw rates of uninsured climb from 2009 to 2011, and half fell.

Apache County had the biggest increase in recent years, jumping from 12.2 percent in 2006 to 24 percent in 2009 before slipping back down to 21.6 percent in 2011.

The overall Arizona rate was largely unchanged from previous years, according to the Census.

Dr. Dan Derksen, director of the Arizona Center for Rural Health, said a lack of coverage was highest among Native Americans and Hispanics in the state, particularly in rural areas in southern Arizona where there is also a lack of health care providers.

"In addition to covering the uninsured, you have to build infrastructure," Derksen said. "We need more health providers and we need more of them in the areas that are underserved."

Many of the residents of Nogales live below the federal poverty level, said Jim Welden, chief executive officer of the Mariposa Community Health Center in the Santa Cruz County city. And of those, Welden said, many who are employed work for small businesses that do not provide health insurance benefits.

"Fundamentally, lack of access to care is an economic issue - so is lack of access to insurance," Welden said. "There are few resources for people beyond our center and the emergency room."

The situation is much the same in Yuma County, where 24.1 percent of residents were uninsured in 2011, and which routinely posts the highest jobless rate in the country.

"If you don't have insurance, that doesn't mean you don't get sick," said Yuma Regional Medical Center Chief Executive Officer Patrick Walz. "But it does mean that you aren't going to see a primary care physician."

Uninsured people do not often get care "at the appropriate level," Walz said, which adds to the cost of treatment because of complications that arise from chronic illnesses and delays in seeking treatment.

The Yuma Regional Medical Center writes off 100 percent of charges for uninsured patients who are at or below the federal poverty level and offers discounts for low-income patients not on Medicaid, Walz said. Welden said the Mariposa center also provides discounts for low-income and uninsured patients.

Derksen said lack of health insurance is one indicator of overall health. Those groups who are less likely to be insured are more likely to have "worse health outcomes" and chronic illnesses, he said.

When federally run health insurance marketplaces begin Oct. 1 as part of federal health care reform, Derksen said he thinks the number of uninsured in Arizona will decrease by as many as 600,000 in the first 24 months.

"This is an unprecedented opportunity to narrow these disparities by lowering the (numbers of) uninsured," he said.

Massachusetts had the highest number of insured in the nation, with fewer than one in 20 lacking health insurance, the Census survey said. Texas was worst in the nation, with the rate of uninsured in the state reaching 25.7 percent in 2011.

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