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The number of Americans without health insurance edged up in 2018 — the first evidence from the government that coverage gains from President Barack Obama’s health care plan might be eroding under President Donald Trump.

The Census Bureau also said in an annual report Tuesday that household income rose last year at its slowest pace in four years and finally matched its previous peak set in 1999. Median household income rose 0.9% in 2018 to an inflation-adjusted $63,179, from $62,626 in 2017.

The data suggest that the economic expansion, now the longest on record at more than 10 years, is still struggling to provide widespread benefits to the U.S. population. Solid gains in household incomes in the past four years have returned the median only to where it was two decades ago. And despite strong growth last year in the number of Americans working full time and year-round, the number of people with private health insurance remained flat.

One bright spot in the report was that the poverty rate fell for a fourth straight year to 11.8%, its lowest point since 2001. The proportion of households led by women that were poor fell to a record low.

“While any reduction in poverty or increase in income is a step in the right direction, most families have just barely made up the ground lost over the past decade,” said Elise Gould, senior economist at the liberal Economic Policy Institute.