For the first time since the Affordable Care Act went into effect, the number of uninsured in America is on its way back up.

In a Gallup poll released earlier this month, researchers found significant increases in the uninsured rate in 17 states in 2017. And for the first time since 2013, no state had an uninsured rate that was lower than the previous year. Here’s the (depressing) rundown. In four states — West Virginia, New Mexico, Iowa and Hawaii — the uninsured rates rose at least three percentage points. Other states with significant increases in people without health insurance include Arizona, Colorado, Florida, Indiana, Illinois, Missouri, New York, North Carolina, South Carolina, Texas, Washington and Wisconsin.

Across the nation, the uninsured rate rose to more than 12 percent in the last part of 2017, up from a low of 10.9 percent in 2016. In 2013, before the ACA was fully implemented, the American uninsured rate was at 18 percent and climbing.

The poll, taken January through December 2017, found that of the 17 states that experienced rises in the uninsured, 10 had expanded Medicaid eligibility — researchers wrote the results “indicate that while Medicaid expansion continues to be associated with greater reductions in the uninsured rate since 2013, it has not generally insulated states from the increase that occurred in 2017.” Overall, the uninsured rate among all states that expanded Medicaid eligibility went up from 8.2 percent in 2016 to 9.1 percent in 2017. The overall uninsurance rate in states that didn’t expand Medicaid went up even more, from 14.5 percent to 15.9 percent.

Massachusetts took the top spot again for least uninsured, at a rate of 4 percent — a ranking it’s received for 10 years in a row. (The state passed its own far-reaching health reform law in 2006.) Researchers noted that before full ACA implementation, Massachusetts was the only state with an uninsured rate below 7 percent; that number went up to 10 states in 2016. A year into Trump’s presidency, the number is back down to five states. The state with the highest uninsured rate is still Texas — a designation it’s gotten for 10 years straight — with more than 22 percent of the population uninsured.

Gallup researchers suggested a number of likely factors that contributed to the rise in the uninsured rate, including the Trump administration’s decision to significantly roll back ACA enrollment outreach, advertising and navigation assistance. They warned that elimination of the individual mandate in 2019 and Trump’s decision to end cost-sharing payments could make the situation worse.

In fact, an issue brief published earlier this week from the Kaiser Family Foundation found that annual financial data from 2017 suggested that the individual market was stabilizing and insurers were making profits — “there was no sign of market collapse.” That suggests insurers were finding a better footing in the new marketplace — one that now guaranteed coverage and a set of basic health services — and that premium increases would get more reasonable. Instead, Trump’s recent ACA measures and proposals will likely pull more healthy people out of the risk pool, leading to much greater premium hikes than was necessary.

“Repeal of the individual mandate as part of tax reform legislation will take effect in 2019, combined with the likely expansion of loosely-regulated short-term insurance plans that could siphon off healthy enrollees from the ACA-regulated individual market,” the Kaiser brief reads. “These changes will increase uncertainty for insurers and likely push premiums higher.”

Get a full copy of the new Gallop poll here.