Health insurance became slightly more scarce in the United States last year, even before the coronavirus pandemic arrived and stole the jobs and health benefits of millions of Americans, according to federal data released Tuesday.

Nearly 30 million people in the country lacked coverage at some point in 2019, 1 million more than the previous year. Last year marked the third year in a row that the ranks of the uninsured swelled, according to a U.S. Census Bureau report regarded as the most solid depiction of the nation’s health insurance landscape.

The report provided contrasting images of Americans’ financial well-being, also showing that the number of people living in poverty continued to decline in 2019. According to the Census figures, the official poverty rate fell to 10.5% last year, compared with 11.8% in 2018, marking the fifth consecutive annual decline in the national poverty rate.

Although the reasons are debated, the new data signals that the first three years of President Donald Trump’s tenure were a period of contracting insurance coverage. They reversed gains that began near the end of the Great Recession and accelerated during early years of expanded access to health plans and Medicaid through the Affordable Care Act. That sprawling law was a signature domestic achievement of President Barack Obama and has been derided by Republicans, including Trump, ever since.

The census findings are laden with political significance, given that polling consistently has shown health care as among the most prominent issues on voters’ minds for the presidential election less than two months away. And the pandemic, in which at least 6.5 million people in the United States have reported cases of the novel coronavirus and deaths are approaching 200,000, has emphasized the importance of being able to afford health care when sick.

As has been true historically, the majority of people with health insurance received it through their job – 55.4%. That is a slight increase from the 55.2% with employer-provided coverage the previous year.

These changes came before the pandemic upended the economy and the health benefits tethered to jobs, leaving millions of Americans suddenly uninsured or turning to Medicaid.

Tuesday’s data also showed that median U.S. income – the point at which half of U.S. families earn more and half earn less – rose to $68,703, up 6.8% from the 2018 median of $64,324.

The 2019 data offers a final snapshot of the United States’ record-long economic expansion, which came to a sudden end when the coronavirus pandemic arrived in the country early this year. By the end of 2019, the unemployment rate was at a 50-year low of 3.5%. Women outnumbered men in the workforce for the second time, buoyed by a tight labor market and fast job growth in health care and education. Minimum-wage increases were also fueling faster wage growth for those at the bottom.

Those historic gains also meant that Americans who had long been marginalized from the workforce were increasingly able to join it. Federal Reserve officials repeatedly heard last year that in low-income communities, particularly communities of color, a tight labor market was a crucial driver of economic growth. Going into 2020, Fed leaders were essentially prepared to let the economy continue to run hot so full employment could be achieved.

But since March, job losses have disproportionately hit low-income workers and women, many of whom held service-sector jobs that were gutted by lockdown measures. Nearly 40% of households with income below $40,000 were laid off or furloughed by early April, according to the Fed. Grocery prices are on the rise as more Americans are pressed to pay for basic staples. And just over half of the 22 million total jobs lost between February and April have not returned.

Meanwhile, the recession is widening America’s long-standing economic inequality. For the wealthiest Americans, a strong stock market, low mortgage rates and recovered job losses mean the downturn is more or less over. But Americans without a stake in the markets, and whose jobs may be permanently wiped away, are struggling to get by, especially as hopes for another Congressional stimulus package fade away.

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