WASHINGTON (Reuters) – The share of Americans without health insurance rose for the first time in a decade last year and U.S. household income barely rose, according to a government report on Tuesday that laid bare issues that could become central to the U.S. presidential election next year.

About 27.5 million residents, or 8.5% of people, did not have health insurance in 2018, an almost 2 million increase from the year before when 7.9% of people lacked coverage, the Census bureau said. It was the first year-to-year increase in the percentage of uninsured people since the Great Recession.

The Trump administration has taken a series of measures, including sharply cutting funding previously provided to groups that help people get health insurance under the Affordable Care Act, also known as Obamacare, that have weakened the law’s benefits and protections.

Some of the largest jumps in the uninsured occurred among Hispanic children, and among middle-class families with income well above the poverty line.

“The decline in public coverage certainly contributed…Private coverage did not statistically change…For children we saw a similar pattern where there was a decline in public coverage and no statistical change in private coverage,” said Laryssa Mykyta, chief of the Health and Disability Statistics branch at the Census bureau, in a conference call with reporters.

Polling shows that healthcare is a top concern for voters leading up to the 2020 election and the states with the largest increases in the uninsured included several potential battleground states.

The gain in the share of uninsured people in Arizona was the largest among states where the Census considered the increase to be statistically significant.

The share of people without insurance also rose in seven other states, including the swing states of Ohio and Michigan. Health insurance coverage expanded in Wyoming, South Carolina and New York.

ECONOMIC STRENGTH BUT INCOMES STALLED

The new data also showed a muddled picture of an economy U.S. President Donald Trump has characterized as the strongest ever and on which he is centering his reelection hopes.

The Census bureau said that the median U.S. household income was $63,179 in 2018, not statistically different from the $62,626 registered in 2017 despite reflecting a year in which U.S. economic growth was boosted by Trump’s tax overhaul and a rise in government spending, the effects of which have begun to wane.

At the end of 2018 the unemployment rate had fallen to 3.9% and has since declined further in what is now the longest U.S. economic expansion in history. But the effects have not been felt equally across the board.

According to regional data released by the Census, median household income inside major U.S. cities grew by a statistically significant 5.4%. Outside those urban areas, in the rural and suburban regions where Trump’s support is strongest, household income barely changed.

The Trump administration’s tax changes, passed into law in late 2017, reduced tax rates for most Americans but were criticized for disproportionately benefiting the wealthy.

Average earnings and the number of fulltime workers have both risen, the data showed, and the benefits have been felt in particular by lower-income families and women. But the flatlining of median household income arrests three years of solid growth.

The poverty rate fell to 11.8% last year from 12.3% in 2017.

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