A new study from the Commonwealth Fund finds the number of people in Kentucky who don’t have health insurance continues to decline since the provisions of the Affordable Care Act fully went into effect in 2014.

Despite these gains, the findings come days after a separate report of nationwide health rankings showed Kentucky still falls near the bottom in terms of health outcomes.

The United Health Foundation released that ranking report on Tuesday, ranking Kentucky’s overall health 42nd in the nation. That number marks an improvement over last year when the state was ranked 45th.

Commonwealth Fund President David Blumenthal said while access to care has gotten stronger, population-level results take time to show.

“It will take a certain amount of time for outcomes to be affected by access to care,” Blumenthal said in a press call.

Only seven percent of adults in Kentucky didn’t have insurance as of 2016, according to the Commonwealth Fund report, a decrease from an uninsurance rate of 21 percent in 2013. But almost a third of Hispanic adults in Kentucky still lack coverage.

The report also found that only twelve percent of Kentuckians went without care because of cost in 2016, down from 19 percent in 2013.

Health Insurance = Better Health?

In general, Sara Collins from the Commonwealth Fund said higher rates of insurance eventually result in better overall health. She said other studies have shown slow improvements in the health outcomes of people who have gained coverage through the Affordable Care Act, whether it be Medicaid or the individual exchange.

“We’re only just beginning to see improvements in health-related outcomes,” Collins said. “And that’s likely a more lagged effect.”

That “lagged effect” is on display in the United Health Foundation’s report.

Kentucky improved very slightly in several factors, including obesity, smoking and diabetes rates. But in other areas, including drug deaths, premature deaths and cancer deaths, 2017’s rates were worse than the year before.

Meanwhile, Kentucky’s gains in health insurance coverage might be at risk. Congressional Republicans tried multiple times this summer to repeal parts of the Affordable Care Act, including the individual mandate, which the health policy experts say would have crashed that insurance market. They also proposed rolling back Medicaid expansion over a number of years. Both of those efforts are still underway in different bills in Congress.

Kentucky is also waiting for the federal government to release final changes to the Medicaid expansion program. The requested changes were submitted by Governor Matt Bevin in 2016, and include measures like requiring recipients to pay premiums, lockout periods and limited enrollment periods. Health experts say these changes will cause people to lose Medicaid coverage. The state has countered that, arguing people will come off Medicaid but gain employer-sponsored coverage because of certain provisions.