In this brief, we assess changes in health insurance coverage and cost-related barriers to health care among adults ages 18 to 64 during the COVID-19 public health emergency following the implementation of policies that aimed to improve access to Medicaid and Marketplace coverage. 

WHY THIS MATTERS

Congress enacted several policies to support coverage and access to affordable health care during the COVID-19 pandemic. These policies included a Medicaid continuous coverage requirement that suspended disenrollments during the public health emergency, enhanced Marketplace premium tax credits, and other safety net program expansions. Seven states also adopted the Affordable Care Act option to expand Medicaid between 2019 and 2022.

Though previous studies have found declines in uninsurance rates during this period, there has been less published analysis on changes in health care access and affordability. Our findings have important implications for efforts to protect coverage and access to care as states unwind the Medicaid continuous coverage requirement and Congress considers extending Marketplace subsidy enhancements beyond 2025.

WHAT WE FOUND

• Between 2019 and 2022, the share of adults who were uninsured at the time of the survey declined from 14.5 percent to 12.4 percent, and the share who had continuous coverage for all 12 months of the past year increased from 82.1 percent to 84.4 percent.
• Adults in states that expanded Medicaid between 2019 and 2022 experienced the largest decline in uninsurance (from 17.2 percent to 11.0 percent) and the largest increase in full-year coverage (from 80.0 percent to 85.8 percent).
• Significant reductions in uninsurance occurred for adults with family incomes below 138 percent of the federal poverty level (FPL) (from 27.9 percent to 23.7 percent) or between 138–249 percent of FPL (from 23.2 percent to 20.6 percent)—the groups that stood to benefit most from the Medicaid continuous coverage requirement and enhanced Marketplace subsidies.
• The share of adults who reported delaying or forgoing needed medical care in the past year because of cost declined from 12.1 percent to 9.7 percent, representing 4.75 million fewer adults.
• As with uninsurance, the largest reductions in cost-related barriers to care occurred in states that expanded Medicaid between 2019 and 2022 (from 15.7 percent to 10.0 percent) and for adults with family incomes below 138 percent (from 20.3 percent to 14.9 percent) or between 138–249 percent of FPL (from 18.4 percent to 14.9 percent).
• We observed similar patterns in the share of adults who did not get needed prescription medications in the past year because of cost or did not take their medications as prescribed to save money, with the total share decreasing from 9.8 percent to 7.5 percent.

Between 2019 and 2022, nonelderly adults experienced reduced uninsurance, increased coverage continuity, and reduced cost-related barriers to care. However, the expiration of the Medicaid continuous coverage requirement and the potential expiration of enhanced Marketplace subsidies could make these trends in coverage and access difficult to sustain.

HOW WE DID IT

Our analysis draws on public and restricted-use 2019 and 2022 data from the National Health Interview Survey, a nationally representative survey of the US civilian noninstitutionalized population. We assessed changes in coverage and cost barriers between 2019 and 2022 for a sample of more than 41,000 adults ages 18 to 64.