We use the Behavioral Risk Factor Surveillance System (BRFSS) to explore state-level changes in access to care over the past for all nonelderly adults and for uninsured adults. Deterioration in access to care was evident in virtually every state and the situation was worse for the uninsured than for other adults in most states. At the end of the decade, the uninsured were at a dramatic disadvantage relative to the insured. This analysis suggests that the potential benefits of the coverage expansion in the Affordable Care Act (ACA) are large and exist in every state.