One goal of health insurance is ensuring people have timely access to primary and preventive care. This issue brief finds wide differences in primary and preventive care access among adults under age 65—across states and within states by income—before the Affordable Care Act’s major insurance expansions took effect. When comparing experiences of adults with insurance, the analysis finds that state and income differences narrow markedly. When insured, middle- and lower-income adults across states are far more likely to have a regular source of care, receive preventive care, and be able to afford care when needed. The findings highlight the potential of expanding health insurance to reduce the steep geographic and income divide in primary and preventive care that existed across the country before 2014. Success will depend on the participation of all states. This brief offers baseline data for states and the nation to track and assess change.