Since the health care law went into effect in 2013, 31 states and the District of Columbia have opted to expand Medicaid, the federal health program for the poor.

From January 2014 to July 2014, more than 8 million Americans gained coverage under the president’s signature health care law. However, 71 percent of those signups were attributed to Medicaid expansion.

Additionally, an October 2015 report found that though more than 9 million Americans gained health insurance in all of 2014, the Medicaid rolls swelled. Of the 9.25 million Americans who enrolled in health coverage, 97 percent—8.99 million Americans—received insurance through Medicaid.

For Americans who receive coverage through their employer or the individual market, many have been faced with skyrocketing premiums and deductibles. Premiums increased in 49 of the 50 states for 2016 on the individual market, with many premiums growing by double digits.