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More data shows continued drop in number of Americans without health insurance

Healthcare
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Americans got yet more good news about the nation's health "uninsured" rate Tuesday. And that could be bad news for Republicans who want to repeal Obamacare.

The number of people who lack health insurance coverage fell by 4 million in 2015, from 33 million without coverage in 2014, to 29 million people last year, U.S. Census Bureau officials revealed.

In percentage terms, 9.1 percent of Americans lacked health insurance in 2015, or 1.3 percentage points less than the prior year.

It was the second year in a row showing declines in all age groups under 65 in their uninsured rates, according to the Census Bureau.

The new findings were released along with other data that showed drops in the nation's poverty rates, and an increase in national median income.

Four states, along with the District of Columbia, had uninsured rates below 5 percent: Massachusetts, Vermont, Hawaii and Minnesota.

The five states with the worst uninsured rates were Florida, Georgia, Oklahoma, Alaska and Texas. In the Lone Star State, a whopping 17.1 percent of residents still lacked health insurance last year.

Census data shows that most Americans are covered by employer-based insurance, followed by Medicaid and Medicare — the two huge government-run health coverage programs — and direct-purchase insurance, which includes Obamacare plans.

A total of 16.3 percent of Americans were covered by direct-purchase plans, a 1.7 percentage point increase over 2014, the biggest single rise of any type of coverage.

The findings are just the latest in a series of reports in the past several years showing big drops in the uninsured rate among Americans after the Affordable Care Act began being fully implemented in 2014 and government-run Obamacare exchanges started selling private health plans.

Last week, the National Health Interview Survey showed that in the first quarter of 2016, the uninsured rate stood at 8.6 percent of Americans, a record low. That survey, which was performed by the federal Centers for Disease Control and Prevention, had a different methodology and timing than the report released by the Census Bureau.

Before the ACA became law in 2010, the nation's uninsured rate stood at just below 16 percent, according to Census data.

The sharp drop since then presents a dilemma for opponents of the ACA, including Republicans who control both houses of Congress and GOP presidential nominee Donald Trump.

Health-care analysts agree that a full repeal of the ACA, without any replacement plan, would lead to millions of newly insured people losing their health coverage. Such a wholesale purge of the coverage rolls would likely spark a political backlash against Republicans.

A glimpse of how bad that backlash could be came in late 2013, when several million Americans had their insurance plans canceled by insurers because the plans didn't comply with Obamacare's minimum standards.

Many of those people obtained new coverage under ACA-compliant plans, and experts agree that the number of people who lost their old plans was dwarfed by the numbers of people who became newly insured. But the Obama administration, which was stung by criticism that the cancellations contradicted President Barack Obama's promise that people would not lose their plans under the new law, quickly moved to grandfather plans at risk of cancellation to allow some people to remain on them.

Repeal of the ACA would lead to many more people actually losing coverage than the number of people who began receiving cancellations for plans in 2013.

An estimated 20 million or so people have gained coverage under the ACA's provisions since 2010. Those provisions include allowing adults under the age of 26 to stay on their parents' plans, expanding Medicaid eligibility to nearly all poor adults in 31 states that adopted expansion and selling subsidized health plans on Obamacare exchanges.

While Republicans including Trump have put forward proposals for replacing Obamacare with a GOP-designed health-care law, it's not clear if those proposals would come close to maintaining coverage for nearly all of the people covered by the ACA.

Another complicating factor for Republicans is that a number of GOP governors, despite their party's opposition to Obamacare, have expanded their individual states' Medicaid programs to cover all adults earning up to 138 percent of the poverty level. Those governors include Ohio's John Kasich, who ran for the party's presidential nomination this year, and Indiana's Mike Pence, who is Trump's running mate.

Census data shows that states that expanded Medicaid experienced bigger drops in their uninsured rates than states that did not. Repealing Obamacare in GOP-led states that have expanded Medicaid could, in turn, put elected Republican officials at risk of keeping their offices from voters upset at losing their coverage, and at risk of losing support from hospitals and other business interests that have backed Medicaid expansion.