About 700,000 fewer people enrolled in health insurance coverage in 2017 compared with the year before, marking the first year that the uninsured rate has increased since the passage of the Affordable Care Act (ACA) in 2013, according to new data.

A new study from the Urban Institute found that the uninsured rate increased 0.2 percentage points from 2016 to 2017.

That means that 10.2% of people under age 65 did not buy health insurance from the individual ACA exchange or obtain it from Medicaid or the Children’s Health Insurance Program.

The strong economy and enrollment gains in the employer-sponsored group insurance market kept the uninsured rate relatively tame, the Urban Institute said.

Coverage losses were concentrated in the 19 states that did not expand Medicaid under the ACA by July 1, 2017, the report said.

In those states, the uninsured rate increased to 14.3% in 2017 from 13.7% the year before.

The uninsured rate held steady at 7.6% in states that did expand Medicaid, the Urban Institute found.

The 10.2% uninsured rate is lower than the 18% of Americans who didn’t have health insurance in 2013, before the ACA was implemented. In total, 27.3 million people were uninsured in 2017.

While Democrat presidential candidates continue to battle it out over how far to go with a Medicaid-for-all program which would put the government in charge of a larger swath of Americans’ health care, the Trump administration succeeded in doing away with the ACA mandate that all U.S. taxpayers need to buy health insurance. This has given Americans the right to choose whether or not they want to purchase individual health insurance on the ACA exchange.

Mostly non-Hispanic whites and non-elderly black people and those with some college decided (or were forced by financial constraints) to gave up their ACA coverage, the Urban Institute found. Delving further into the demographics of the uninsured, rates increased most for women, young adults and lower-income individuals, the study said.

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