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WASHINGTON – Fewer Americans are putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act.

The report — based on a state-by-state survey of data collected by the federal government — provides powerful new evidence that insurance gains made through the 2010 health care law are helping millions of patients get needed medical care.

And the report’s findings, which parallel a growing body of research into the law’s effect, undercut arguments by the Trump administration and congressional Republicans who have tried to discredit and roll back the law.

“The Affordable Care Act has put access to health care in reach for millions of Americans, particularly for people in states that embraced the law,” conclude the authors of the report, published by the nonprofit Commonwealth Fund.

Getting care: Indeed, nine of the 11 states with the biggest decline in the share of residents who delayed care because of cost concerns expanded Medicaid through the law and worked aggressively to enroll their residents in coverage, the report found.

These include California, where the percentage of people delaying care dropped to 11 percent from 16 percent between 2013 and 2016.

California also has recorded some of the biggest coverage gains since the health care law’s expansion began in 2014, with the percentage of uninsured working-age adults falling to 10 percent from 24 percent, according to the report.

Across the country, the law is credited with extending health coverage to more than 20 million previously uninsured Americans and dropping the nation’s uninsured rate to the lowest levels ever recorded.

Republican response: Republican politicians, in their bid to repeal the law, have consistently tried to dismiss these gains as immaterial to patients’ health and access to medical care.

In a speech last month to state Medicaid directors, Seema Verma, whom President Donald Trump tapped to oversee the Medicare and Medicaid health insurance programs, disparaged the decrease in the uninsured as a “hollow victory of numbers covered.”

But the new report indicates that the coverage gains have in fact had a very real effect on patients’ lives.

Between 2013 and 2016, the share of adults reporting that they delayed medical care because of concerns about cost decreased in 45 states.

The percentage of adults at risk of being in poor health who had not been to the doctor in the previous two years decreased in 37 states.

And the share of working-age adults with high out-of-pocket medical bills fell in 35 states between 2013-14 and 2015-16, according to the report, which is based on census data and national health surveys overseen by the Centers for Disease Control and Prevention.

These gains were particularly pronounced among low-income Americans, who have arguably benefited most from the 2010 law’s coverage expansion.

In five states – Arizona, Kentucky, Oregon, Washington and West Virginia — the percentage of working-age, low-income adults who reported delaying care because of cost fell by 10 percentage points or more between 2013 and 2016.

In Oregon, the rate was cut in half, from 35 percent to 17 percent.

All five states have expanded Medicaid eligibility through the health care law to cover low-income, working-age adults.

“Medicaid made a clear difference in reducing cost barriers to care for low-income and minority adults,” the report says.

Access: An increasing number of studies have found similarly dramatic improvements in patients’ access to care after they get coverage.

“The fact is health insurance helps people get access to care, gets them better preventive care and more regular care for chronic medical conditions,” said Dr. Benjamin Sommers, a health policy researcher at Harvard who has extensively studied the effect of health insurance.

“The notion that the gain in coverage is an empty number is flatly contradicted by literally dozens of scientific studies.”

A study of Medicaid recipients in Oregon released last week found that patients who gained coverage through the program were substantially more likely to get recommended medications to treat serious conditions such as diabetes and mental illness.

“Having access to medications that are prescribed for them, rather than using those that had been prescribed to someone else and might not be safe or appropriate for them, represents a major improvement in the quality and safety of care,” said Katherine Baicker, that study’s lead author and dean of the University of Chicago Harris School of Public Policy.

Other studies have shown that improved access often leads to better results, including helping poor patients better control conditions such as asthma and high blood pressure.

Still other research suggests that the coverage expansions made possible by the Affordable Care Act ultimately will save lives.

That is what researchers found in Massachusetts after that state enacted its trailblazing coverage expansion in 2006, a model that was replicated in the federal law that President Barack Obama signed in 2010.

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