AUSTIN, Texas (Texas News Service) — More children in Texas and around the nation have health coverage. That’s the good news according to a new report from the Georgetown University Center for Children and Families, but Texas also leads the nation in the number of children without insurance.

Nationwide, the report found the rate of uninsured children dropped to a historic low of six percent in 2014, the year the Affordable Care Act (ACA) went into effect.

Anne Dunkelberg with the Center for Public Policy Priorities cites the expansion of Medicaid eligibility for adults under the ACA – a move Texas has yet to make – as a significant factor for the increased coverage of kids.

“Folks usually refer to that as the so-called ‘welcome mat’ effect,” says Dunkelberg. “When you put out the welcome mat and say, ‘We have coverage for everybody,’ then you end up getting whole families enrolled, and that gets more children covered as well.”

The report found that from 2013 to 2014, the uninsured rate for Texas children declined from 12.6 percent to 11 percent, down from an estimated 888,000 uninsured children to just under 784,000. Dunkelberg says with that many kids in Texas still without coverage, there’s clearly more work to do. According to the study, nearly 4.4 million children in the U.S. still don’t have health insurance.

The report also found that after the rollout of the ACA, 25 states recorded declines in the number of uninsured children, and no state showed significant increases.

Study co-author Joan Alker, executive director at Georgetown’s Center for Children and Families, says the study confirms that years of work by policymakers and other stakeholders to reform health care in the U.S. is beginning to pay off.

“The Affordable Care Act, which is a significant domestic policy initiative, was really building on a decade of success for kids with Medicaid and CHIP,” she says. “But we did see a significant decline from 7.1 percent to six percent in the rate of uninsured kids.”

The report also found that Hispanic and school-aged children were disproportionately uninsured, as well as children living in rural areas or low-income families. Alker says if more states decide to expand adult eligibility for Medicaid coverage, uninsured rates for children could drop even further.