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WASHINGTON — The number of uninsured South Carolina residents has dropped about 10 percent in the past year, according to a new survey.

A Gallup survey estimated the state's uninsured rate at 16.8 percent in June, down from 18.7 percent in 2013. If the estimate holds up for the rest of the year and is confirmed by government data, it would be the lowest uninsured rate in the state in many years.

"We had hovered around 20 percent for far too long," said Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center. "It's going in the right direction but it can go a whole lot further."

The Gallup-Healthways Well-Being Index survey of almost 89,000 people nationally showed all 50 states with shrinking numbers of uninsured. States that expanded their Medicaid programs under the Affordable Care Act and opted to run their own online insurance marketplaces saw even bigger reductions.

President Barack Obama and advocates of the 2010 health care law say the survey is one of several showing the law has made a dent in uninsured rates.

"Millions of people have gained coverage because of the ACA, and millions more could if the remaining states did the right thing and expanded Medicaid," White House spokeswoman Kaelan Richards said.

States that have expanded Medicaid and created their own marketplaces for residents to shop for private health insurance — key pieces of the Affordable Care Act — lowered their uninsured rate by 25 percent on average, according to the Gallup survey. States that did one or neither of those things saw an average reduction of 12 percent.

South Carolina did not expand Medicaid eligibility to more lower-income adults and did not create its own online marketplace. Instead, it uses the federal government's marketplace, HealthCare.gov.

About 146,000 people in South Carolina found health insurance on HealthCare.gov during the six-month open enrollment period, according to federal data released in May.

About 80 percent of those people selected a private health insurance plan, and the rest were eligible for Medicaid. The federal government has not yet identified how many of those enrollees were previously uninsured.

The Gallup data is an estimate based on a survey and its margin of error could be as high as 5 percentage points in smaller states. But researchers say it matches the general trend found by several other studies of the uninsured population since the Affordable Care Act took effect. Medicaid-expansion states like Arkansas and Kentucky, for example, saw reductions of 45 percent and 42 percent.

"Unfortunately, official government statistics on what happened to coverage in 2014 are not likely to be available until into 2015, if not late 2014," said Rachel Garfield, a senior researcher for the Kaiser Family Foundation and associate director of its Kaiser Commission on Medicaid and the Uninsured.

The slight dip in South Carolina's uninsured rate may have other causes, such as an improved economy and a lower unemployment rate. State officials aren't convinced the survey proves that expanding Medicaid is the best way to reduce the ranks of the uninsured.

South Carolina's director of Health and Human Services, Tony Keck, said getting a truer assessment of the law's impact will require another open enrollment period and another year of data.

He said South Carolina, even without expanding eligibility for Medicaid, added 50,000 children and 30,000 adults through the state's own outreach and through the HealthCare.gov marketplace, which refers people to the state's Medicaid program if they qualify. But state hospital executives have told him they haven't seen much difference in the number of uninsured patients.

"I don't know at this point quite what to make of it," Keck said.

About half of states have expanded Medicaid to include all adults under 65, with or without dependent children, who earn less than 138 percent of the federal poverty level, or about $27,000 for a family of three. The federal government pays the full cost of expansion for the first three years. Its share later drops to 90 percent.

Rather than expand Medicaid, Keck said South Carolina is focused on the sickest of the uninsured who frequent emergency rooms. He said the state helps those people tap options such as free health clinics and hospital-provided charity care.

The state's Healthy Outcomes program has helped 8,500 people this year, Keck said. He hopes to increase that to 12,000-15,000 next year. It's not insurance, but it does help people with chronic conditions — those who use the most health care resources — get treatment, he said.

"I call the Medicaid expansion trickle-down public health," he said. "You flood the market with money through the insurance companies, the pharmaceutical companies and the hospitals and you hope it trickles down to the people who need it most. The reality is, that's not happening."

Gov. Nikki Haley has rejected the Medicaid expansion option.

"We have a different approach than what others are taking, and I guess we'll know in five years which is best," Keck said.

Keck said he expects the number of uninsured state residents — now about 800,000 — to continue to decrease. About half qualify for a subsidy through the Affordable Care Act to help pay for health insurance premiums.

"I think probably in the next enrollment period these numbers will be pushing down. The economics of it are too powerful," he said.

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