Rising health care costs and growing numbers of uninsured are key policy issues in both Kentucky and nationally. This study evaluates how health insurance coverage in Kentucky changed during Governor Ernie Fletcher's term. Although insurance coverage fell overall, the picture is complicated with some groups making gains and others losing ground. In terms of uninsured, Kentucky fell from 28th to 33rd, with the percentage uninsured rising from 13.6% to 15.6% from 2002 to 2006. Insurance coverage for children improved, due to increasing private coverage. Coverage for young adults worsened significantly, due to falling public coverage.