The early effects of the Affordable Care Act brought some “modest” gains in health care access, quality, avoidable hospital use, cost, and health outcomes to communities, according to a report released by the Commonwealth Fund.

The analysis, titled “Scorecard on Local Health System Performance,” is the first edition of the report to include results from the implementation of many important ACA provisions, such as the opening of the health insurance exchanges, by looking at 33 indicators of health care performance in 306 hospital referral regions.

“In nearly all local areas (302 of 306), healthcare improved more than it worsened,” the report said. “This means that in many places across the country, previously uninsured people gained health insurance—in large part because of the Affordable Care Act’s coverage expansions—and more people reported they were able to get needed care. In addition, many people received higher-quality care, and fewer were readmitted to the hospital than just a few years ago.”

Nationally, hospital referral regions saw the most consistent signs of improvement in better mobility for home health patients (improved in 255 of the 306 regions), mortality 30 days after a hospital stay (209 of 306), the number of uninsured people between the ages of 19 and 64 (189 of 306), and 30-day hospital readmissions for Medicare beneficiaries (155 of 306).

Akron, Ohio, and Stockton, Calififornia, were the most improved regions, scoring higher in 19 of the 33 categories.

There wasn’t improvement in all categories. Obesity worsened in 111 of the 306 regions, while rates of premature deaths from treatable conditions remained relatively unchanged in all but eight regions.

The report credited the ACA with improving the uninsured rates in many areas, including greater declines in regions where Medicaid was expanded. Another ACA program, Medicare’s Hospital Readmission Reduction Program, may have been responsible for an accelerated decrease in Medicare beneficiaries returning to the hospital within 30 days.

“The local areas making the most progress averaged a nearly 30 percent reduction” between 2012 and 2014, according to the report.

Performance in many categories varied widely based on geography, however. Areas in Texas and the Southeast saw the least amount of improvement on uninsured rates, with several regions still having a quarter of adults between 19 and 64 without coverage. Infant mortality was also higher in the Southeast, with than 10 deaths per 1,000 live deaths recorded in parts of Georgia, Mississippi and South Carolina—rates which the report said are comparable to those in Serbia and China.