Prior to the passing of the Affordable Care Act in 2010 – commonly referred to as “Obamacare” – most insurance providers would issue policies based on a customer’s current health and health history. For this reason, many Americans with preexisting conditions were denied access to private health insurance and treatment. According to the Kaiser Family Foundation, the number of American adults under 65 years old with such health conditions is now 27%.

The share of people with preexisting conditions that would be denied coverage under the pre-ACA system varies from state to state. Poorer states such as West Virginia, Mississippi, and Alabama often have the largest shares of the population with a preexisting condition. In fact, the five states with the lowest median household incomes in the country are also those with the greatest shares of people suffering preexisting conditions.

41. Massachusetts
> Population w/ preexisting conditions: 24% (tied)
> Pct. uninsured: 2.8% (the lowest)
> Median household income: $70,628 (6th highest)
> Life expectancy at birth: 80.7 (tied for 4th highest)

The average life expectancy in these states is also lower than average – likely, at least in part, due to the poor health of the populations.While the national life expectancy at birth is nearly 79 years, life expectancies do not exceed 76 years in seven of the 10 states with the highest share of people with preexisting conditions. Conversely, the life expectancy of the populations in those states with the lowest shares of people with preexisting conditions is generally around 80 years.

Before the Affordable Care Act, insurance companies could deny coverage based on conditions such as Crohn’s disease, obesity, and even pregnancy. Repeal may result in the return of such policies, unless other protections are put in place.

Click here to see how many people have preexisting conditions in every state.

24/7 Wall St. analyzed data from the Kaiser Family Foundation on the number of Americans that have health conditions that would likely leave them uninsurable by private providers prior to the ACA. Data on the percentage of the each state’s population without health insurance coverage and median household income for each state is from the U.S. Census Bureau’s 2015 American Community Survey one-year estimates. We also included 2013 life expectancy at birth from the Institute for Health Metrics and Evaluation, a global health research center affiliated with the University of Washington.