The number of Americans without health insurance surged by 2.3 million under Donald Trump's presidency, a new report from Capital & Main revealed.

Meanwhile, under Joe Biden's presidency, 3.3 million more Americans had insurance than in 2019.

The report looked at the U.S. Census data and showed that the national uninsured rate dropped by 1.2 percent under Biden. That also marked the lowest rate of residents without health insurance in U.S. history.

Health care remains a top issue ahead of the upcoming presidential election. In a recent Pew Research Center survey, 57 percent of Americans called health care affordability a "very big problem," and just under 30 million people do not have health insurance today, the report found.

When it comes to Trump's track record, the number of insured Americans might not be a selling point, as 39 states saw their numbers of uninsured increase. In the swing states of Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania and Wisconsin, there were 440,000 more uninsured people under the Trump administration.

For Biden's presidency, the number of uninsured Americans decreased in six out of seven swing states, with 580,000 fewer insured people noted on the Census.

The changes in insured Americans likely result from the two presidents' different policies. While Trump worked against President Barack Obama's Affordable Care Act, Biden has worked to provide more coverage to Americans and undo some of Trump's prior decisions.

Trump initially pledged to voters in 2016 that he'd get rid of the ACA and replace it. In 2017, the ACA was nearly eradicated save for a single vote by Republican Senator John McCain that upheld the law.

Still, during Trump's presidency, it became more difficult to apply for coverage through the ACA's insurance marketplace, and the open enrollment period was significantly limited. Trump also lowered the advertising budget for the ACA by 90 percent.

"Under Trump, we saw a systematic dismantling of the Affordable Care Act. It wasn't a full repeal, but death by a thousand cuts," Michael Ryan, a finance expert and the founder of michaelryanmoney.com, told Newsweek.

"They slashed funding for enrollment assistance. Expanded those skimpy short-term plans. And effectively killed the individual mandate. It's like taking the engine out of a car and expecting it to still run smoothly."

There was also a reversal of the penalty for Americans who did not sign up for health insurance, which likely led to many opting to stay uninsured.

Trump also made the public charge rule stronger, so the government rejected green cards and visas for immigrants who received Medicaid at higher rates.

Some large Republican-run states saw significant increases in the uninsured population. While Texas saw the population grow by around 700,000, Florida also saw 240,000 more uninsured during the Trump presidency.

When the coronavirus hit, Trump relaxed his policies on Medicaid and agreed to extend Medicaid coverage until the pandemic was no longer a health emergency. This meant Americans no longer had to prove eligibility to stay on the government-run health insurance, but that policy ended in March of 2023.

"The results, as we now see, were unfortunately fewer people with health insurance, but at the same point, some of the pandemic-era policies that expanded health insurance under Trump and the succeeding Biden administration lead to more receiving coverage," Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek. "While it has taken a backseat in this election cycle, the affordability of healthcare remains a key issue for millions of Americans."

Eight days after Biden was inaugurated, he signed an executive order that expanded Medicaid enrollment and gave people more time to sign up for health care plans.

And in 2021, Biden passed the American Rescue Act, which increased the availability of subsidies for lower-income Americans looking to get health insurance from the ACA, and the Inflation Reduction Act saw those rules continue through 2025.

"It's not perfect, but it's slowly moving the needle in the other direction," Ryan said. "Do I pay for my medication or put food on the table? That's not a choice anyone should have to make in a country as wealthy as ours."

The end of continuous coverage for Medicaid has hurt the number of insured people in America. According to the CDC, the uninsured rate grew from 7.7 percent to 8.2 percent between the first quarters of 2023 and 2024. A recent estimate from the Congressional Budget Office also indicated that the uninsured population could skyrocket by 6 million people by 2034, based on recent numbers.

During his current campaign, Trump has not said specifically that he would try once again to get rid of the ACA, but Project 2025, which is the Republican proposal from the think tank Heritage Foundation, indicates support for implementing a lifetime cap on Medicaid benefits. It is unclear if Trump would push for the specific policies outlined by Project 2025.

Trump's current Democratic presidential competitor, Kamala Harris, has said she would work to increase subsidies for ACA and cancel medical debt for millions.

Newsweek reached out to Trump and Biden for comment.

Looking at the upcoming election, Ryan said voters may not remember which administration was responsible for expanding or restricting their access to care.

"Voters need to look beyond the soundbites," Ryan said. "Dig into the nitty-gritty of each candidate's healthcare platform. Because at the end of the day, this isn't about politics. It's about whether Americans can afford to get sick without going broke."

Beene echoed this sentiment.

"Whoever wins in November will have a major impact on whether health insurance continues to see an expansion of coverage nationally or sees the declines that became common prior to the pandemic," Beene said.