The percentage of Maine residents without health insurance dropped from 8 percent to 5.7 percent over three years, according to a new report from the U.S. Census.

The state now has the 14th-lowest uninsured rate in the nation, although it remains the highest in New England, according to the census.

The drop is primarily the result of Medicaid eligibility expansion in 2019, and represents the largest decline among the states from 2019-21, the latest year statistics were available. About 99,000 Maine people now have Medicaid insurance. Medicaid, also known here as MaineCare, is insurance for low-income people funded with a blend of federal and state dollars.

Massachusetts, which enacted insurance coverage reforms in the 2000s that preceded the Affordable Care Act, has the lowest uninsured rate in the nation at 2.5 percent. Nationally, the uninsured rate declined from 9.2 percent in 2019 to 8.6 percent in 2021.

Maine’s uninsured rate is now about half what it was a decade ago. The percentage of Maine residents without insurance was 11.2 percent in 2013, the year before the Affordable Care Act was implemented, according to the census.

New England states have among the nation’s lowest uninsured rates, with Vermont recording the second-lowest at 3.7 percent, and Rhode Island, Connecticut and New Hampshire are all among the 10 lowest. There are still 14 states that have refused to expand Medicaid under the Affordable Care Act, including Texas and most states in the Southeast. Texas has the highest uninsured rate in the country with 18 percent lacking coverage.

Medicaid expansion was mandatory under the Affordable Care Act, but the U.S. Supreme Court ruled in 2012 that states must decide whether to participate in the expansion. Former Maine Gov. Paul LePage – who is now running for a third non-consecutive term in November against incumbent Gov. Janet Mills – opposed broadening eligibility and vetoed legislative efforts to expand Medicaid. LePage also refused to expand Medicaid during his last year in office in 2018 after voters overwhelmingly approved the expansion in a 2017 referendum.

Mills implemented the expansion when she took office in 2019. Maine went from having the nation’s 26th-lowest uninsured rate in 2019 (8 percent) to 14th in 2021 (5.7 percent).

Nearly 100,000 Maine residents have Medicaid insurance who were not eligible prior to 2019, although not all of them were previously uninsured. Some switched from Affordable Care Act coverage to Medicaid once the expansion went into effect. ACA enrollment in Maine peaked in 2016 at about 84,000 people, and is now about 66,000, according to the Kaiser Family Foundation and state statistics.

“Having health insurance saves lives. That’s why since my first day in office, I have fought to make health care more accessible and more affordable for all Maine people. This report shows we are succeeding,” Mills said in a written statement.