The rollout of the Affordable Care Act has had its hiccups to be sure. But the biggest question in finding out whether those who need it get health insurance coverage may be which political party runs the state.

The 10 states with the highest uninsured rates in the country, all run by Republican governors or legislatures or both, have all refused to accept the expansion of Medicaid and have declined to participate in the state exchanges. Those states are Texas, Mississippi, Georgia, Florida, Louisiana, Montana, Arizona, Oklahoma, Alaska, and New Mexico.

However, the states with the largest drop in uninsured residents, Kentucky and Arkansas, have embraced the ACA reforms, even though those states are also led by Republicans, according to a new Gallup poll. Arkansas, which accepted the Medicaid expansion but uses the money to purchase private insurance, saw its uninsured drop from 22.5% of state residents to 12.4%. Kentucky’s uninsured rate fell from 20.4% to 11.9% of its population.

Last year, 14 states had more than 20% of their population uninsured. This year, there are only three such states: Texas, Georgia and Mississippi, with Florida and Louisiana next on the list. Texas, which has refused to cooperate with the implementation of the ACA, saw its uninsured rate fall only 3%, to 24%, leaving it as the state with the highest percentage of uninsured.

The nationwide rate of uninsured Americans has fallen from 18% in 2013 to 13.4% now. States that accepted the Medicaid expansion and created their own exchanges saw their uninsured rates fall by 4%, while states that fought the ACA had only a 2.2% decrease in uninsured.

-Steve Straehley

To Learn More:

Divide Between Red And Blue States Over Healthcare Deepens (by David Lauter, Los Angeles Times)

Arkansas, Kentucky Report Sharpest Drops in Uninsured Rate (by Dan Witters, Gallup)

The States With The Highest Uninsurance Rates Are All Led By Republicans (by Tara Culp-Ressler, Think Progress)

Best State In America: Arkansas, For Reducing Its Uninsured (by Reid Wilson, Washington Post)

Missouri Government Fights to Keep Health Insurance from Uninsured (by Matt Bewig, AllGov)

Governors from States with Most Uninsured Oppose Expanding Health Insurance for Uninsured (by Noel Brinkerhoff, AllGov)