Donald Trump

President-elect Donald Trump, shown during a recent post-election rally in Alabama, says he will repeal and replace the Affordable Care Act. Advocates of the healthcare law are ramping up their efforts to preserve it.

(Brynn Anderson, Associated Press)

WASHINGTON, D.C. -- For all of Obamacare's faults, millions of American want to keep it, hoping to retain the health insurance they didn't have before.

Yet Republican Congress members and President-elect Donald Trump ran for office saying they would repeal the landmark healthcare act, which has driven up insurance premiums in some markets and driven out insurers in others. So now, as enrollment updates and new figures on improved access to care are rolling in, lobbying efforts by Obamacare advocates are ramping up.

One reason: The number of adults under age 65 without health coverage has dropped from 20 percent to 13 percent nationwide, according to an analysis released Wednesday.

In Ohio, where Gov. John Kasich expanded Medicaid coverage for low-income adults as part of Obamacare, the share of residents without any health coverage fell from 16 percent to 9 percent. And the number of black Ohioans who lacked health insurance dropped from 22 percent in 2013 to 12 percent in 2015.

The pre- and post-Obamacare figures are part of a new report by the Commonwealth Fund, a foundation that advocates for access to care for vulnerable populations. It used information from the U.S. Census Bureau and survey figures backed by the Centers for Disease Control and Prevention and other government agencies.

"It's important to hold on to these gains and continue to make progress in ensuring that people can get and afford the healthcare they need," said Dr. David Blumenthal, the Commonwealth Fund's president.

A confluence of studies and events:

Sylvia Mathews Burwell, President Barack Obama's secretary of Heath and Human Services, is scheduled to release more Obamacare data today.

People who wanted new or continuing coverage starting Jan. 1 had to sign up by midnight Monday, and Burwell will announce the number of Americans who did so, with a state-by-state breakdown.

Even if her facts and figures are based on hard numbers, they will almost certainly be used for partisan political purposes. That's because Republicans in Congress are mapping out plans to repeal Obamacare, formally called the Affordable Care Act, and Democrats need the numbers to fight back.

Republicans, controlling both houses of Congress, say they will replace parts of the act and want to assure that Americans most in need of coverage still can get it. Congressional leaders have discussed offering tax credits to offset individuals' cost of insurance. They have proposed establishing a high-risk insurance pool to assure care for people whose pre-existing conditions would render coverage unaffordable or unobtainable.

But high-risk pools could be expensive for the government. Without the act's federal mandate to buy insurance or pay a fine -- intended as a way to balance out costs among the healthy and the sick, but viewed by critics as trampling on individual rights -- it remains unclear how this will play out.

Applying pressure:

And so groups hoping to keep key parts Obamacare are applying pressure where they can.

On Monday, 30 healthcare or allied groups in Ohio wrote to Kasich urging him to ask Congress to preserve core tenets of the law, including financial assistance to make heath coverage affordable. This followed a request by U.S. House of Representatives Republicans for governors to provide their input to Congress.

The Ohioans' letter said that with full repeal, 964,000 Ohioans would lose health coverage, a figure that comes from the Urban Institute, a left-leaning think tank that studies economics and social policy.

"At this critical juncture, we ask you to convey to Congress and the President-elect that repeal should not take place without a clear plan that makes care better for everyone," said the letter. Signatories included the Ohio Association of Area Agencies on Aging, the Ohio Association of Food Banks and the Ohio Council of Churches.

Asked how Kasich might reply, Connie Luck, spokeswoman for Kasich's Office of Health Transformation, said in an email that "we are in the process of developing our response" to Congress "and feel it would be premature to comment at this time."

Dreaming and singing:

Advocates tried to amplify their message with a megaphone Tuesday. About 100 gathered outside the Columbus office of U.S. Sen Rob Portman, a Republican who supports repeal-and-replace.

They gave speeches. They waved signs ("Senator Portman: Don't take away healthcare for 965,000 Ohioans.")

Doctors and nurses joined them as they sang Christmas carols, adapting new words.

"I'm dreaming of some good healthcare," went one lyric, to the melody of "White Christmas." "Senator Portman do us right."

And as a substitute for "Jingle Bells":

"Healthcare now, healthcare now, healthcare all the way. We won't go until we know, we'll fight for some each day."

Democratic senators want something, too:

Meantime, 19 Democratic U.S. senators wrote to Trump on Tuesday to urge him to act on another facet of healthcare: high prescription costs. Among other things, they want to give HHS permission to negotiate the prices of drugs used by seniors on Medicare.

Congressional Republicans have blocked such efforts before, saying the Medicare market is so large that price negotiations would affect the entire pharmaceutical industry. Their concern in the past was two-fold: that this would amount to government price-fixing, and that by forcing down prices, the government could harm the industry by stifling innovation.

But the senators, led by Ohio's Sherrod Brown and Minnesota's Al Franken, show little love for the industry.

Drug companies, their letter said, "have often engaged in abusive tactics that price lifesaving drugs out of reach for those in need." The American public, they added, "is fed up."

Trump, too, has talked about reducing drug prices. How he would do it is not yet known.