11. Wyoming
> Ppt change in uninsured rate, 2012-2015: -3.3
> Expanded Medicaid?: no
> Pct. population without health insurance, 2012: 15.4% (17th highest)
> Pct. population without health insurance, 2015: 12.1% (10th highest)

In 2012, before the state’s Health Insurance Marketplace open enrollment period began, 15.4% of Wyoming’s population did not have health insurance. Today, 12.1% of people are uninsured, 3 percentage points higher than the nationwide rate of uninsured population 9.1%.

Wyoming is one of 20 states without an expanded Medicaid program under Obamacare. The state also did not develop its own exchange. Instead, residents must visit healthcare.gov to purchase health insurnace. According to Kowalski’s research, states that ceded full control of the ACA adoption to the federal government tended to have higher health care costs. A typical non-smoking, middle-aged male paid health insurance premiums of slightly less than $400 per month, the second-most expensive of any state.

12. Kansas
> Ppt change in uninsured rate, 2012-2015: -3.3
> Expanded Medicaid?: no
> Pct. population without health insurance, 2012: 12.6% (21st lowest)
> Pct. population without health insurance, 2015: 9.3% (19th highest)

After the first open enrollment in the Health Insurance Marketplace began on October 1, 2013, health insurance coverage in every state increased. In Kansas, the percentage of the population without health insurance decreased from 12.6% in 2012 to 9.3% as of March this year. The improvement of 3.3 percentage points was smaller than the national decline in the rate of uninsured Americans of 5.7 percentage points.

Unlike some states, Kansas was not proactive on health care reform. The state did not implement a state exchange nor did it expand Medicaid coverage. If Kansas expands Medicaid, an estimated 100,000 additional residents would gain health insurance and the uninsured rate would drop to 5.8%.

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13. Pennsylvania
> Ppt change in uninsured rate, 2012-2015: -3.5
> Expanded Medicaid?: yes
> Pct. population without health insurance, 2012: 9.8% (9th lowest)
> Pct. population without health insurance, 2015: 6.3% (17th lowest)

In 2012, before the state’s Health Insurance Marketplace open enrollment period began, 1.2 million Pennsylvania residents, or 9.8% of the population, did not have health insurance. Since then, the share of residents without health insurance coverage fell 3.5 percentage points to 6.3%. The percentage of Americans without health insurance dropped 5.7 percentage points over that period to 9.1%.

Former Pennsylvania Governor Tom Corbett expanded the state’s Medicaid program in August last year, and was one of a minority of Republican governors to do so. However, Corbett’s health plan was unusual compared to the Medicaid expansion in other states. Current Governor Tom Wolf, a democrat, overhauled the system early this year, and claims it now offers coverage to more state residents.

14. Missouri
> Ppt change in uninsured rate, 2012-2015: -3.5
> Expanded Medicaid?: no
> Pct. population without health insurance, 2012: 13.6% (25th lowest)
> Pct. population without health insurance, 2015: 10.1% (15th highest)

Missouri did not expand Medicaid under Obamacare, and the state ceded full control of the act’s implementation to the federal government — residents must visit healthcare.gov to purchase health insurance. If the state elects to expand Medicaid, the federal government estimates an additional 253,000 Missouri residents would be covered and the uninsured share of the population would fall further to 5.8%.

Still, there was some improvement. Three years ago, 13.6% of Missouri residents did not have health insurance, the 25th lowest uninsured rate in the country. The rate improved during the open enrollment period, and today, 10.1% of Missouri’s population is without insurance, the 15th highest share of uninsured citizens of all states.

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15. Wisconsin
> Ppt change in uninsured rate, 2012-2015: -3.6
> Expanded Medicaid?: no
> Pct. population without health insurance, 2012: 9.0% (7th lowest)
> Pct. population without health insurance, 2015: 5.4% (10th lowest)

Three years ago, 9.0% of Wisconsin residents did not have health insurance, the seventh lowest uninsured rate in the country. The rate further improved during the open enrollment period, and today, only 5.4% of Wisconsin’s population is without insurance, the 10th lowest share of all states. While average premiums were not significantly higher in states that did not expand Medicaid, the average premium for a 40-year-old, nonsmoking man was $308, fifth highest in the country.