The number of uninsured veterans in the U.S. declined by nearly 40% from 2013 to 2015, but that number could drop even more if more states opt to expand Medicaid, according to a new report.

The Urban Institute and the Robert Wood Johnson Foundation found that the number of uninsured veterans ages 19-64 dropped from 980,000 in 2013 to 552,000 in 2015, according to a study published Wednesday.

The majority of the coverage gains occurred in states that decided to expand Medicaid coverage under the Affordable Care Act. The uninsured rates among veterans averaged 4.8% in expansion states compared to 7.1% in non-expansion states in 2015.

The study estimated that an additional 110,000 veterans could gain coverage if states that opted not to expand Medicaid reversed course.

Medicaid expansion has been a hot-button issue amid efforts to repeal the ACA. Nineteen states have chosen not to expand Medicaid. But there has been renewed pushes in state legislatures to expand coverage after federal lawmakers failed to repeal the ACA in March, in part due to moderate Republicans’ desire to preserve the expansions.

“The evidence suggests that the ACA, particularly Medicaid expansion, helped (veterans). Absent similar provisions, coverage levels for veterans are likely to deteriorate,” said Jenny Haley, co-author of the study and research associate for the Urban Institute’s Health Policy Center.

But states that didn’t expand Medicaid still saw insurance gains, the groups found, thanks to exchange plans or employer-sponsored insurance.

Nearly a quarter of uninsured veterans qualified for Medicaid coverage through expansion, but didn’t enroll in the option. This is likely because “they don’t know they are eligible,” Haley said, noting prior research has shown qualified individuals don’t realize they now fall under Medicaid.

Haley said veterans’ organizations should strengthen outreach with state and federal health agencies to alert their members of their Medicaid eligibility.

The study’s numbers also don’t reflect states that have expanded Medicaid since 2015—Alaska, Montana and Louisiana.

Overall, 5% of veterans and their family members, an estimated 939,000 people, lacked health insurance in 2015, down from 1.7 million people in 2013.

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Medicaid expansion drives drop in uninsured veterans –