After the implementation of the Affordable Care Act, people in a majority of states were less likely to skip doctors' visits because of concerns about the cost of care, according to a new report that attempts to paint a snapshot of the effects of the law as its days are numbered.

Census data released this fall revealed that the overall uninsured rate had reached a historic low in 2015. What those broad trends meant about health — or even access to care — was less clear.

The new analysis by the Commonwealth Fund details the decline in the rate of uninsured people in each state between 2013 and 2015, highlighting that those with the biggest declines were states that expanded Medicaid — a provision of the Affordable Care Act, commonly called Obamacare.

It also found that in 38 states and the District of Columbia, the percentage of adults who said they avoided medical care because of its cost declined by at least two points over the three-year period.

That trend was most pronounced in Kentucky, Oregon and Arkansas, where the rate of adults avoiding care dropped at least 5 percentage points. Those states also had some of the biggest changes in the uninsured rate, according to the analysis.

The researchers also looked, state by state, at how many non-elderly adults went without a routine visit to the doctor over the past two years. They focused on people who could most benefit from preventive care, including people who were older than 50, had “fair” or “poor” health or had conditions such as diabetes or strokes. In all but three states, the percentage of at-risk adults who went without a doctor's visit in the past two years improved or stayed the same.

The researchers also looked at the proportion of non-elderly adults in each state burdened by health-care costs, spending more than 10 percent of their income on health care — or more than 5 percent, if their income was less than double the federal poverty level.

They found that there were regional differences. In the Northeast and the mid-Atlantic, there were relatively fewer people facing a high out-of-pocket burden. Meanwhile, in the South, a larger portion of people faced high heath-care costs.

In a conference call, David Blumenthal, president of the Commonwealth Fund, was asked about why Kentucky — which saw the biggest decline in the uninsurance rate — went for president-elect Trump, when many voters presumably benefited from expanded access to health care. Kentucky's non-elderly uninsured rate dropped from 21 percent in 2013 to 8 percent in 2015.

“I think this is a really perplexing point,” Blumenthal said. “There clearly is a disconnect between people benefiting from this particular program and their political perception about which candidates they want to support.”

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