WASHINGTON — About 12 percent of north country residents under age 65 had no health insurance in 2009, a level slightly below New York and national averages, the Census Bureau reported.

The rate, virtually unchanged from a year earlier, reflects New York’s efforts to trim the number of people without insurance by expanding eligibility for Medicaid and other subsidized health programs, according to the Healthcare Association of New York State.

It also may reflect the north country’s relatively high number of people in government jobs, including people employed at Fort Drum, prisons and public universities.

The Census Bureau reported that the percentage of people age 65 and younger without insurance was 12.7 percent in Jefferson County, compared with 12.9 percent the prior year, and 12.7 percent in St. Lawrence, unchanged.

In Lewis County, the rate went from 12.7 percent to 12.1 percent.

“The state’s been aggressive about eligibility,” said William Van Slyke, vice president for communications at the Healthcare Association of New York State, which represents hospitals and other health care institutions. People with incomes four times the poverty rate can qualify for some subsidized insurance, such as Medicaid, he said.

“We’ve nearly doubled Medicaid enrollments,” Mr. Van Slyke said.

The Affordable Care Act signed into law by President Barack Obama does not fully take effect until 2014, when a federal requirement to carry health insurance is implemented. When it does, the administration predicts, the rate of uninsured will drop sharply, as it did in Massachusetts after former Gov. Mitt Romney signed a state-level health insurance mandate into law.

The rate in Massachusetts was 4.4 percent uninsured in 2009, the Census Bureau reported.

There is general agreement in health care circles that the uninsured drive up costs for society as a whole, but strong disagreements about whether an insurance mandate is an appropriate way to address that. The mandate faces a challenge at the U.S. Supreme Court.

Although the law promises to reduce the rate of uninsured, it also pressures states to shrink eligibility for government-subsidized insurance, Mr. Van Slyke said.

The rate of uninsured under age 65 in New York was 13.2 percent in 2009; the uninsured rate for all ages last year was 15 percent.

The states with the highest rates of uninsured included Texas at 26.3 percent, Florida at 24.9 percent, Nevada at 24.5 percent and Montana at 21.7 percent. The Census Bureau released county statistics in early October.

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