Imagine if every resident in Pinellas Park or Wesley Chapel lost their health insurance. The Census Bureau estimates that is about how many additional Floridians lacked health coverage last year. The Republican administrations in Washington and Tallahassee are to blame for this disturbing trend, and it’s no wonder health care remains a top issue in the 2020 elections.

Florida continues to rank near the top of a national list no one should brag about: The number of uninsured residents. A recent Census report shows the portion of Floridians without health insurance ticked up in 2018 from 12. 9 percent to 13 percent, or more than 2.7 million residents. That’s an estimated increase of 52,000 Floridians, and only Texas, Oklahoma and Georgia have higher uninsured rates. The nation’s third-largest state should do better by its residents, and the Florida Legislature should make increasing coverage a priority rather than viewing health care as an expensive cost burden that needs to be reined in.

For example, Republican legislative leaders still refuse consider accepting billions in federal dollars to expand Medicaid as 36 other states have done. That alone would cover hundreds of thousands of additional low-income Floridians, and the federal government would pay 90 percent of the cost. Instead, the Florida House passed legislation this spring that would have required non-disabled adults to work or participate in education or community service activities to receive Medicaid. That would have put at risk the eligibility of about 500,000 Floridians covered by Medicaid, and while the the Senate did not consider the proposal it will be resurrected when the 2020 legislative session begins in January.

Of course, the Trump administration’s actions on a variety of fronts also have contributed to reducing access to health insurance. After it failed to convince Congress to repeal the Affordable Care Act, it severely cut money spent on advertising and providing help to residents looking to get coverage through the federal marketplace. For the second straight year, it will spend just $10 million nationwide on that critical outreach when enrollment opens Nov. 1. The individual mandate has been repealed, and nothing has been done to encourage more insurers to offer coverage in areas that are under-served. Yet even against those headwinds, consumers will have more choices in many states and premiums will drop a bit for 2020.

Health care coverage also appears to be collateral damage from the Trump administration’s anti-immigration policies. Hispanic residents were the only major racial and ethnic group who experienced a significant change, with the national uninsured rate rising by 1.6 percentage points in 2018. The uninsured rate among immigrant children who have become citizens rose by 2.2 percentage points. The administration’s efforts to restrict both legal and illegal immigration appears to be discouraging families from seeking public health care coverage for their kids who are eligible for it.

The Affordable Care Act became law nine years ago, and it has made a positive difference in making health insurance more available despite the persistent partisan efforts by Republicans to undermine it. But the law is far from perfect. The census report that shows the first increase in the number of uninsured nationally and in Florida in nearly a decade is a warning sign, and voters looking ahead to the 2020 election should demand candidates suggest realistic ways to make health coverage more affordable and accessible.

Editorials are the institutional voice of the Tampa Bay Times. The members of the Editorial Board are Times Chairman and CEO Paul Tash, Editor of Editorials Tim Nickens, and editorial writers Elizabeth Djinis, John Hill and Jim Verhulst. Follow @TBTimes_Opinion on Twitter for more opinion news.