U.S. metropolitan areas are characterized by pronounced disparities in rates of health insurance coverage and access to care. While it has been well documented that people with lower incomes run a greater risk of being uninsured than those with higher incomes, this study also finds a strong relationship between a city’s rate of employer-sponsored health coverage and its overall rates of health coverage and access to care. We examined health insurance coverage and access to health care among moderate- and low-income, nonelderly residents of the nation’s largest metropolitan areas. Our key findings are: There is great variation in uninsured rates across U.S. cities, ranging from a high of 37 percent in El Paso, Texas, to a low of 7 percent in both Akron, Ohio, and Harrisburg, Pennsylvania (see Exhibit ES-1). There is great variation in rates of employer-based health coverage across cities, from 84 percent in Milwaukee, Wisconsin, to just 49 percent in El Paso, Texas (see exhibit ES-2). Those with lower incomes are especially at risk. Among residents with incomes below 250 percent of the poverty level, uninsured rates vary from 11 percent in Honolulu to 50 percent in El Paso. The uninsured are much less likely to have a regular source of health care or to have seen a physician in the last year; they are also much more likely to delay seeking care. Residents of cities with high uninsured rates generally have a harder time getting the health care they need than those living in cities with relatively low uninsured rates. The negative impact of high uninsured rates affects individuals with moderate incomes well above the poverty level.