There is encouraging news today from the U.S. Census Bureau:  Almost 9 million Americans gained health coverage in 2014 due to the Affordable Care Act. The national uninsured rate dropped from 13.3 percent to 10.4 percent — even though the poverty rate and median household income were unchanged from the previous year.

But the story is not as rosy in Louisiana, which is one of 21 states that have refused to extend Medicaid coverage to low-income adults using federal dollars. Louisiana’s uninsured rate dropped from 16.6 percent in 2013 to 14.8 percent, which means 80,000 Louisianans got covered. But a staggering 672,000 Louisianans were still uninsured, leaving them with limited access to doctors and hospitals and vulnerable to financial calamity in case of an illness or injury.

“Today’s Census numbers provide more evidence for what we already knew: The Affordable Care Act is working, but Louisiana simply can’t afford to keep turning away federal dollars that are desperately needed to help struggling families get health coverage,” LBP Director Jan Moller said.

The new data shows Louisiana is losing ground to other states because of its failure to expand coverage. In 2013, Louisiana ranked 11th highest for the share of residents without health insurance. But in 2014, Louisiana jumped to seventh on that list as Medicaid expansion states made greater progress. Four states—Arizona, California, Mississippi and New Mexico—jumped ahead of Louisiana. Three of the four (all except Mississippi) expanded Medicaid.