Health care is a major concern for candidates and constituents in the 2020 election, especially in a battleground state like Pennsylvania.

A recent study from Public Policy Polling finds health care is a key issue for 69 percent of voters in Arizona, Florida, Pennsylvania, Michigan, Wisconsin, and Texas — all of which are considered 2020 battleground states.

And new data shows thousands of Pennsylvanians are actually losing health insurance, likely upping the stakes of health-care policy for the upcoming presidential election.

According to a September report from the U.S. Census Bureau, the number of Pennsylvanians without health insurance rose by nearly 7,000 between 2017 and 2018. That means 699,000 Pennsylvanians were uninsured in 2018, compared to 692,000 in 2017.

Nationwide, about 535,000 people lost health insurance coverage. Pennsylvania fared better than many states in terms of losing coverage. For example, Texas had 186,000 fewer people on health insurance in 2018 compared to 2017, while some states added thousands of insured residents.

Overall, Pennsylvania ranks as the state with the 12th-lowest uninsured rate.

However, data published by the bureau suggests that this is the first time the number of Pennsylvanians without insurance has increased since 2013. Between 2013 and 2016, the percentage of uninsured individuals dropped from 9.7 percent to 5.6, and decreased again in 2017 to 5.5 percent, where it remains now.

Nationwide, the percentage without health insurance fell from 14.5 percent to 8.7 percent between 2013 and 2017, but rose to 8.9 percent in 2018. The drop could be attributed to rising premiums. ACA marketplace premiums in Pennsylvania increased significantly between 2017 and 2018, with the average lowest-cost bronze premium option jumping from $286 monthly to $365. The lowest-cost silver premium also increased more than $100, from $371 in 2017 to $494 in 2018.

In response, Pennsylvania has made headway in stabilizing premiums across the state, with an average decrease of 2.3 percent in 2019.

U.S. Sen. Bob Casey, D-Pa., supports protecting the ACA, especially under a GOP-controlled Senate set on repealing it. If the ACA were to be fully repealed, 858,000 people in Pennsylvania and 19.9 million across the United States could be left without access to health insurance.

One of President Donald Trump’s campaign promises was to fully repeal the ACA, and replace it with an alternative. In 2017, the Republican-controlled Senate, under the leadership of Sen. Mitch McConnell, R-Ky., spent weeks trying to repeal the law with no success. Using the decision from Texas v. United States as its basis, the most recent lawsuit filed by the Trump administration against the ACA is seeking to strike down all parts of the law, including protections for those with pre-existing conditions.

On July 2, Gov. Tom Wolf signed legislation that would shift Pennsylvania from the ACA marketplace to a state-based exchange. The law is meant to be in full effect by 2021 and could decrease premiums by 5 percent to 10 percent.