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Across the U.S., the effects of the Patient Protection and Affordable Care Act's coverage mandate and expanded options for health insurance access have been obvious. Millions of people who previously did not have health insurance now do, and there were significant declines in uninsurance rates for states where the problem used to be rampant.

From 2013 through the end of last year, six states saw declines in uninsurance rates of at least 10 percentage points, in large part because they were also states where Medicaid was expanded to provide coverage for more low-income families, according to the latest data from Gallup and Healthways' Well-Being Index. Another four states saw declines of at least 9 percentage points. During that same period, the national uninsurance rate slid 6.4 points.

Millions more people have health insurance now, but they face an uncertain future.Millions more people have health insurance now, but they face an uncertain future.

Who led the way?
The state with the single largest drop in the percentage of its population without health insurance was Kentucky, where only about 7.8 percent of residents didn't have coverage through the end of 2016, the data showed. That was down from 20.4 percent – one of the highest rates in the country – just three years earlier. Not far behind, representing the only other state where uninsurance dipped at least 12 points, was Arkansas. There, 10.2 percent of residents didn't have some sort of health coverage, down from 22.5 percent.

Other states in this group included West Virginia (down 11.5 percent), New Mexico (11.2 percent), California (11.1 percent) and Oregon (10.3 percent), the report said. Washington, Arizona, Montana and Louisiana rounded out the top 10.

Two different stories
In Minnesota, which now boasts one of the lowest uninsurance rates in the country (5.6 percent), work continues to make sure the state-run health insurance market is as effective as possible, according to National Public Radio. The state legislature recently passed a measure to provide financial support for consumers whose premiums had risen sharply from one year to the next, decided against allowing insurers to offer less expensive, minimal coverage, and started work on figuring out a public option.

Meanwhile, in Idaho – where the uninsurance rate is still well above the national average at 14 percent – some experts are concerned about the changing health care landscape and what that will mean for their coverage in the near future, according to the Teton Valley News. About 105,000 state residents signed up for the state's ACA exchanges this year, meaning they will be guaranteed coverage for the remainder of 2017. After that, however, things could shift dramatically.

“It is unclear what will change and when it will change,” Teton Valley Healthcare CEO Keith Gnagey told the newspaper. “The short term issue is how insurance companies move forward and plan for their 2018 plan years. Until Congress acts on legislation, we are still following the Affordable Care Act.”

With all this in mind, it might be incumbent upon health insurers to make sure their policyholders know what they're going to have to deal with as time goes on, and how they can adequately prepare themselves for any changes they encounter.