It’s been years since the Affordable Care Act — also known as Obamacare — has been passed, but a full 32.3 million non-elderly people remain without health insurance.

Even with the individual mandate tax penalty and a costly health reform act, a tremendous number of Americans aren’t being convinced to sign up for health insurance, according to a Fox Business report.

The Kaiser Family Foundation published new state-by-state numbers on the epidemic of uninsured Americans, finding that more than quarter of the uninsured are eligible adults or children.

It represents a sort of glass half full or half empty situation: the Obama Administration is likely to point to the millions of new individuals who are insured now thanks to the act, while others are concerned at the vast amounts of people who still haven’t signed up. As a result of the large numbers of uninsured people, hospitals remain under a lot of financial pressure.

The health care issue wasn’t addressed much at the Democratic presidential debate, but Republican candidates have vowed to do away with the ACA, including Jeb Bush, who unveiled a health care reform plan that would include replacing Obamacare to “stop the damage Washington central planners have caused for decades,” according to the report.

The largest uninsured numbers are not surprisingly in the largest states: California, Texas, and Florida, with a full 4.4 million Texans uninsured even though nearly a quarter of them were eligible for tax credits, and 11 percent were eligible for Medicaid. There were similar numbers for other states. In Florida, nearly a third were eligible for tax credits.

Obamacare’s third open enrollment is set to begin on Nov. 1, and will mark another critical period for the nascent law that remains under siege from Republicans. The White House is pushing to raise the rate of insured Americans by focusing on areas that have high rates of uninsured residents.