The contentious issue of health care coverage was thrust back into the election spotlight this week when House Speaker Mike Johnson told supporters there would be “no Obamacare” if Donald Trump and congressional Republicans prevail on Nov. 5.

Johnson’s comment cast attention on a potential liability for Trump, who as president led an unsuccessful effort to repeal the Affordable Care Act — and then proceeded to weaken the popular health care law. His actions contributed to an increase of more than 2.2 million in the number of uninsured U.S. residents during the first three years of his term.

In the final days of his campaign, Trump is holding rallies in the critical swing states of North Carolina, Michigan, Wisconsin, Georgia and Pennsylvania. In those states alone, the number of uninsured rose by nearly 300,000 during Trump’s first three years in office.

In Georgia, where Trump will appear on Monday, the number of people without health insurance increased by more than 88,000 during his first three years in office. By contrast, the number of uninsured residents dropped by more than 164,000 in the Peach State over the first three years of the Biden administration, according to Census data analyzed by Capital & Main with support from Thomas Data Consulting.

Three years into Trump’s presidency, the uninsured population increased in 39 states, rising by more than 440,000 in the seven battleground states alone.

The Trump campaign sought to distance itself from Johnson’s comment, telling NBC News, “Repealing Obamacare is not President Trump’s policy position.” Johnson also denied that he had called for the end of the ACA, blaming “dishonest characterizations from the Harris campaign.” Harris spokesperson Sarafina Chitika dismissed Johnson’s denial, saying, “Voters heard it from his own mouth: If Trump wins there will be ‘no Obamacare,’ plain and simple.”

In contrast to Trump, President Joe Biden worked to shore up the Affordable Care Act, contributing to the lowest recorded uninsurance rate. Over the first three years of Biden’s administration, the nation saw a decrease of more than 3 million in the number of uninsured residents. Experts also attribute the reduction in the number of uninsured U.S. residents to pandemic-era policies put in place under both presidents that temporarily expanded Medicaid enrollment and increased subsidies for private insurance.

Across the seven battleground states — Pennsylvania, Wisconsin, Michigan, North Carolina, Georgia, Nevada and Arizona — 630,000 fewer people lacked health insurance three years into Biden’s term. A total of 46 states saw reductions in the number of uninsured in that time.

Capital & Main reached out to the Trump campaign for comment and had not heard back before this story was published.

Even if Trump and a Republican-controlled Congress do not seek to repeal the ACA, the stakes for health care in this election are high. That’s because pandemic-era subsidies that lowered the cost of ACA marketplace premiums are set to expire at the end of next year unless Congress and the next president’s administration take action to preserve them.

Vice President Kamala Harris has promised to make the enhanced subsidies on premiums permanent, while Trump has made no such commitment. Given his record of undermining the ACA, the prospect of a Trump victory has many people concerned.