North Carolina experienced another drop in the number of individuals without health insurance to a record low of 10.4 percent in 2016, according to data released Tuesday by the U.S. Census Bureau.

However, the rate could be significantly lower if the Republican-controlled General Assembly approved expanding Medicaid coverage to more than 500,000 of the 1.04 million North Carolinians who still lack health insurance.

The national average for uninsured individuals is 8.6 percent, with private health insurance covering 67.5 percent of Americans and Medicare and Medicaid covering 37.3 percent. There is some overlap between the groups of people who have private and government-provided insurance.

Since the federal Affordable Care Act went into full effect in 2014, the share of people without insurance in North Carolina has dropped from 15.6 percent.

“This latest report reminds us that, despite some improvement, the state still struggles with having a large number people who lack affordable health care coverage,” said Mark Hall, a professor of law and public health at Wake Forest University and a national expert on health-care policies.

As expected, reaction to the Census data typically depended on which side analysts and economists fall on the Medicaid expansion debate.

States that have expanded Medicaid under the ACA are covering a higher share of people with insurance than states that did not expand Medicaid.

For example, of the 21 states whose uninsured rate is above the national average, 14 have not expanded Medicaid coverage under the ACA.

“Over time, changes in the rate of health insurance coverage and the distribution of coverage types may reflect economic trends, shifts in the demographic composition of the population, and policy changes that affect access to health care,” according to the Census news release.

N.C. Republican legislative leaders have been so opposed to Medicaid expansion — primarily out of concerns that the federal government wouldn’t pay its 90 percent to 95 percent financial cost share — that many consider the proposal a non-starter.

So much so that Senate leader Phil Berger, R-Rockingham, and House Speaker Tim Moore, R-Cleveland, have sued in federal court to prevent Democratic Gov. Roy Cooper from fulfilling a campaign pledge to expand Medicaid.

The uncertainty of the ACA under the Trump administration, and the Republican-controlled Congress’ inability to push its goal of repeal and replace, has put on hold the state’s Medicaid waiver request plan to federal health agencies that was submitted in June 2016.

Rep. Donny Lambeth, R-Forsyth, and the legislature’s lead health-care expert, said it could be December before he gets an update on the waiver request from federal health agencies.

“We must protect the progress that the Affordable Care Act has made by rejecting further efforts to repeal this law,” said Nicole Dozier, director of the Health Advocacy Project at left-leaning N.C. Justice Center.

Mitch Kokai, a policy analyst with Libertarian think tank John Locke Foundation, said he has not been surprised by the decreasing state uninsured rate via the ACA.

“Force people to buy insurance or pay a penalty, and it shouldn’t surprise you when more people end up buying insurance,” Kokai said.

“What might be more surprising is the fact that the Affordable Care Act, with all of its disruption of the health care marketplace, has left so many people still lacking insurance.”

Kokai said he does not expect the Census report “to do much to move the needle in the political debate over health care in North Carolina.”

“Gov. Cooper and his team want to expand Medicaid. Some elements within the state House are amenable to the idea. The state Senate has opposed the idea.

“As long as Cooper continues to fight lawmakers on so many other fronts, it seems unlikely that those same lawmakers will have much interest in taking his side in this debate.”

John Dinan, a political science professor at Wake Forest, also said he doesn’t believe the Census data will play a pivotal role in shifting opinions on Medicaid expansion.

“As long as the legislature continues to oppose Medicaid expansion, North Carolina is likely to remain one of the 19 states not participating in this aspect of the ACA,” Dinan said.

rcraver@wsjournal.com 336-727-7376 @rcraverWSJ

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