Earlier this year I traveled to Appalachia to photograph the effect of The Affordable Care Act/Obamacare on residents of Breathitt County in Eastern Kentucky. Most of the people I encountered received coverage under the medicaid expansion portion of Obamamcare. Like much of Appalachia, Breathitt County has suffered from the decline of the coal industry in addition to the nationwide economic downturn.

Jeff Fletcher, 52, smokes a cigarette alongside his dogs Snoopy (left) and Walter (right) after standing for portrait near his mobile home on Thursday, November 21, 2013 in Jackson, Ky. Fletcher, an uninsured resident of Breathitt County, was able to enroll in the Affordable Care Act earlier in the day through Kentucky's health exchange. Luke Sharrett for The Washington Post

The sun sets on Main Street in downtown Jackson, Ky. on Wednesday, November 20, 2013. Due to poverty and the decline of the coal industry in Appalachia, many residents cannot afford health insurance and are uninsured or rely on the government for their health care needs. Luke Sharrett for The Washington Post

A rusting railroad switcher that once serviced the Kentucky May Coal Company sits idle on a siding on Wednesday, November 20, 2013 in Jackson, Ky. Luke Sharrett for The Washington Post

ackson residents Troy Hensley (2nd from right) and Christine Hensley (far right) watch as a building is torn down on Wednesday, November 20, 2013 in Jackson, Ky. "They're tearing all the old buildings down and leaving nothing but empty lots," Troy said. "There ain't nothing around here for the old people to walk to anymore." Once a booming Appalachian railroad town, Jackson has fallen on hard times like many other Eastern Kentucky coal communities. Luke Sharrett for The Washington Post

Cemetery graves stand on a hillside in Jackson Cemetery on Thursday, November 21, 2013 in Jackson, Ky. Luke Sharrett for The Washington Post

Main street is reflected in a store window on Wednesday, November 20, 2013 in Jackson, Ky. Luke Sharrett for The Washington Post

Kentucky health care exchange navigator Courtney Lively waits for enrollees to show up during an Affordable Care Act enrollment event at Highland-Turner Elementary School on Wednesday, November 20, 2013 in Owsley, Ky. Luke Sharrett for The Washington Post

 (L-R) Jeff Fletcher, an uninsured resident of Breathitt County, laughs after enrolling in the Affordable Care Act with the help of Kentucky health care exchange navigator Courtney Lively at the Breathitt County Family Health Center on Thursday, November 21, 2013 in Jackson, Ky. Luke Sharrett for The Washington Post

 A Hardee's fast food restaurant stands next door to the Breathitt County Family Health Center on Tuesday, January 21, 2014 in Jackson, Ky. Residents of Breathitt County who enrolled in the Affordable Care Act last year were able to seek treatment as of January, 1, 2014. Luke Sharrett for The Washington Post

Snow-covered vehicles sit along Kentucky Route 378 on Tuesday, January 21, 2014 in Vancleve, Ky. Breathitt County resident Mary Blair lives farther up the Route 378 and was able to gain health insurance through Medicaid expansion under the Affordable Care Act. Luke Sharrett for The Washington Post

Breathitt County resident Mary Blair sits for a portrait inside her mobile home on Tuesday, January 21, 2014 in Vancleve, Ky. Despite suffering from a past heart attack and diabetes Blair was able to receive medical coverage through Medicaid expansion under the Affordable Care Act. Luke Sharrett for The Washington Post

Shawnetell Allenee Combs, 6, plays with her grandparents' dogs Snoopy (Left) and Oreo (Right) in front of the mobile home where she lives with her grandparents Jeff and Sandy Fletcher on Thursday, November 21, 2013 in Jackson, Ky. Combs has health coverage through Medicaid. Luke Sharrett for The Washington Post

Jeff Fletcher's dog, Walter, sits in front of his mobile home on Thursday, November 21, 2013 in Jackson, Ky. Fletcher, an uninsured resident of Breathitt County, was able to enroll in the Affordable Care Act earlier in the day through Kentucky's health exchange. Luke Sharrett for The Washington Post

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**Photos copyright Luke Sharrett and The New York Times**