doctors are employed by the government. Multiple surveys indicate the number of uninsured fell between 2013 and 2016 due to expanded Medicaid eligibility and health insurance exchanges established due to the Patient Protection and Affordable Care Act, also known as the "ACA" or "Obamacare". According to the United States Census Bureau, in 2012 there were 45.6 million people in the US (14.8% of the under-65 population) who were without health insurance. This figure fell by 18.3 million (40%) to 27.3 million (8.6% of the under-65 population) by 2016. However, under President Trump these gains in healthcare coverage have begun to reverse. The Commonwealth Fund estimated in May 2018 that the number of uninsured increased by four million from early 2016 to early 2018. The rate of those uninsured increased from 12.7% in 2016 to 15.5%. The impact was greater among lower-income adults, who had a higher uninsured rate than higher-income adults. Regionally, the South and West had higher uninsured rates than the North and East. Further, those 18 states that have not expanded Medicaid had a higher uninsured rate than those that did. According to Physicians for a National Health Program, this lack of insurance causes roughly 48,000 unnecessary deaths per year. The group's methodology has been criticized by John C. Goodman for not looking at cause of death or tracking insurance status changes over time, including the time of death. A 2009 study by former Clinton policy adviser Richard Kronick found no increased mortality from being uninsured after certain risk factors were controlled for. Outcomes The U.S. lags in overall healthcare performance but is a global leader in medical innovation. America solely developed or contributed significantly to nine of the top ten most important medical innovations since 1975 as ranked by a 2001 poll of physicians, while the EU and Switzerland together contributed to five. Since 1966, Americans have received more Nobel Prizes in Medicine than the rest of the world combined. From 1989 to 2002, four times more money was invested in private biotechnology companies in America than in Europe. Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States ranked at or near the top in obesity rate, frequency of automobile use and accidents, homicides, infant mortality rate, incidence of heart and lung disease, sexually transmitted infections, adolescent pregnancies, recreational drug or alcohol deaths, injuries, and rates of disability. Together, such