Despite the economic ravages of the COVID-19 pandemic, the percentage of adults in the United States without health insurance held steady at approximately 11 percent, a new analysis shows. Researchers saw large shifts in the source of coverage for many people, as pandemic-related layoffs decreased the number of people receiving health insurance through their employers and increased enrollment in public coverage programs.
The Urban Institute analysis, funded by the Robert Wood Johnson Foundation, examined changes in health insurance coverage among nonelderly adults. Researchers found that between March 2019 and April 2021:
- The percentage of U.S. adults reporting they had employer-sponsored coverage declined from 65 to 62.3 percent, a decrease of approximately 5.5 million adults.
- The share of adults reporting public coverage increased from 13.6 to 17.5 percent, an increase of approximately 7.9 million adults.
- Public coverage gains occurred in states that did and did not expand access to Medicaid under the ACA:
- The percent of adults reporting public coverage in states that expanded Medicaid increased from 14.9 percent to 19.2 percent.
- The percent of adults reporting public coverage in nonexpansion states increased from 10.7 percent to 14.3 percent.
- In April 2021, the uninsurance rate in nonexpansion states was more than double that of expansion states (18.2% versus 7.7%).
- More than one in three low-income adults in nonexpansion states were uninsured in 2021, compared with about one in seven low-income adults in expansion states.
“Unlike the last recession, losses in employer-sponsored insurance during the pandemic did not lead to growth in the number of uninsured,” said Michael Karpman, senior research associate at the Urban Institute. “Medicaid and the health insurance Marketplaces provided many people with a safety net that allowed them to maintain coverage during difficult times.”
“Those who suffered the most from the economic fallout associated with COVID were low wage workers, so the loss of job-related coverage was less than in previous recessions,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. “The enhanced safety net provided by the ACA was critical in keeping people covered, especially in states that expanded Medicaid.”
The brief uses data from the Urban Institute’s Health Reform Monitoring Survey, a nationally representative, internet-based survey of adults ages 18 to 64, conducted in March 2019, March/April 2020, and April 2021. Approximately 9,000 to 9,500 adults participated in each survey round.