By John Tozzi for Bloomberg

The number of Americans without health insurance increased by almost 2 million people in 2018, according to new data released by the U.S. Census Bureau Tuesday.

The increase in the rate of uninsured, from 7.9% in 2017 to 8.5% last year, is particularly remarkable given the falling unemployment rate during that period, since most Americans get coverage through work. The Census Bureau said it was the first meaningful uptick in the number of people without health coverage since 2009.

While the economy grew in 2018, individual health insurance premiums continued to increase, while states tightened eligibility requirements for public safety-net coverage and President Donald Trump carried on in his attempt to undo much of the Affordable Care Act, the signature health law of his predecessor, Barack Obama.

The Census report indicates that the biggest decrease in coverage in 2018 came among those covered by Medicaid, the state-federal health program for low-income Americans. Almost two million fewer people were covered by Medicaid in 2018 than in the prior year.

The Census Bureau said the uninsured rate increased in eight states — Alabama, Arizona, Idaho, Ohio, Michigan, Tennessee, Texas and Washington state. It decreased in New York, South Carolina and Wyoming.

By income, the largest increases in people without any coverage were among those with incomes at least three times the poverty level, or about $75,000 for a family of four. Many in those households earn too much to get most of their health premiums subsidized by the government, so they’re most exposed to high premiums for employer coverage or on the ACA marketplaces.

The growing number of uninsured Americans sets the stage for an increasingly heated political fight over health care in America. Democrats running for president have attacked Trump for his attempts to roll back the ACA, including a lawsuit supported by the Justice Department arguing that the law is unconstitutional. Their agendas range from expanding the ACA to replacing it with a Medicare-for-All single-payer system.

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