This brief uses American Community Survey data to examine changes in insurance coverage between 2013 and 2014 for all 50 states and the District of Columbia, and for 24 of the largest metropolitan statistical areas. Coverage gains varied considerably among states and metropolitan statistical areas, with Medicaid expansion states generally having larger gains in coverage than nonexpansion states. In expansion states, Medicaid coverage increases largely drove the reductions in the uninsured rate, but increases in private nongroup coverage also contributed. The reverse was true in nonexpansion states, where reductions in the uninsured rate were almost all driven by nongroup coverage.