The rate of American denizens living without health insurance has surged to 13.7% in the last quarter of 2018 from 12.4% a year ago, according to a survey report released by Gallup.

Due to the higher insurance premiums and availability of fewer ACA health exchanges, the level of uninsured in the last quarter of 2018 was the highest since the beginning of 2014, according to the poll.

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Gathered as part of the Gallup national health and well-being index, these data are based on Americans’ answers to the question, “Do you have health insurance coverage?”

Sample sizes of randomly selected adults were approximately 28,000 per quarter in 2018.

In a statement, the management consulting company said: “While still below the 18% high point recorded before implementation of the Affordable Care Act’s (ACA) individual health insurance mandate in 2014, today’s level is the highest in more than 4 years, and well above the low point of 10.9% reached in 2016.”

The study found that uninsured rate was most among young adults under the age of 35, and women living in households with annual incomes of less than $48,000 per year.

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The young adults under the age of 35 reported an uninsured rate of over 21%, a 4.8-point increase from two years earlier. And the rate among women marks the fastest rising, from 8.9% in late 2016 to 12.8% by the end of 2018.

West, Midwest, and South all reported increases in the uninsured rate of more than 3 percentage points. The South reported a 3.8-percentage-point increase to 19.6% while the rate in the East stood at 7.1%, almost steady since the end of 2016.