The recession caused by the COVID-19 pandemic is expected to lead to losses of employer-sponsored health insurance coverage (ESI) and a rise in uninsurance, testing the health care safety net established by the Affordable Care Act (ACA). In this brief, we provide the first nationally representative estimates of changes in coverage during the initial months of the recession.
We focus on changes occurring between late March/early April and mid-to-late May for all adults ages 18 to 64 and for those whose families lost jobs because of the pandemic, both nationally and within states that have expanded Medicaid under the ACA and states that have not done so. Our analysis uses longitudinal data from the first wave of the Urban Institute’s Coronavirus Tracking Survey, fielded May 14 through 27, 2020, and the Health Reform Monitoring Survey, fielded March 25 through April 10, 2020. We find the following:
- Though coverage did not change between March/April and May for the overall sample, adults in families losing jobs reported a 4.9 percentage-point decline in ESI during this period, from 59.0 percent to 54.1 percent, and a 3.5 percentage-point increase in private nongroup coverage, from 7.9 percent to 11.4 percent.
- Among adults in families losing jobs in Medicaid expansion states, the share reporting ESI fell 4.2 percentage points, from 61.2 percent to 56.9 percent, between March/April and May. The share of these adults reporting Medicaid/CHIP coverage increased 2.0 percentage points, from 14.5 percent to 16.5 percent. Uninsurance remained unchanged in these states, both overall and among those in families losing jobs.
- Uninsurance increased by 1.4 percentage points among adults in nonexpansion states, from 15.7 percent to 17.0 percent. Among adults in families losing jobs in these states, ESI coverage fell by 6.2 percentage points, from 54.2 percent to 48.0 percent, and nongroup coverage increased by 7.0 percentage points.
These findings suggest the ACA may be protecting adults who lose jobs during the pandemic from becoming uninsured, even as the administration filed a brief supporting a challenge to the law before the Supreme Court that, if successful, would place approximately 20 million Americans at risk of becoming uninsured.