Report: Healthcare Uninsurance Rate Held Steady During Pandemic

Public insurers such as Medicaid, especially in states that expanded coverage under the ACA, kept people insured.

The number of people covered by employer-based insurance dipped because of COVID-19 related layoffs, but public insurers such as Medicaid kept people insured, according to a report released earlier this month by Urban Institute.

The Institute’s Health Monitoring Survey focused on changes in coverage across three surveys: March 2019; March/April 2020, just after the pandemic caused a steep decline in employment; and April 2021, more than one year after the secretary of health and human services declared a national public health emergency.

Between March 2019 and April 2021, the share of nonelderly adults reporting employer-sponsored insurance coverage declined from 65% to 62.3%, a decrease of about 5.5 million adults. But the national uninsured rate was steady at about 11%.

Keeping people insured was Medicaid, especially in states that expanded coverage under the Affordable Care Act (ACA).

In total, the share reporting public coverage increased from 13.6% to 17.5% percent, an increase of about 7.9 million adults. In Medicaid expansion states, the uninsurance rate was near 8% across all three study years. In nonexpansion states, the uninsurance rate was higher in 2021 (18.2%) than in 2020 (16.5%) and 2019 (17.2%). People living in states that did not expand Medicaid under the ACA were more than twice as likely as those living in expansion states to be uninsured in 2021.

Those most likely to lose employer-based insurance were those with low and moderate incomes. Among adults with incomes at or below 138% of the federal poverty level, the share reporting public coverage increased from 54.6% to 62.9% in Medicaid expansion states and from 30.4% to 37.3% in nonexpansion states between 2019 and 2021.

The growth in public coverage reflects several factors, the authors said, including expanded Medicaid eligibility under the ACA and the stopping efforts to remove people from Medicaid under the Families First Coronavirus Response Act, which was a temporary law under the Family and Medical Leave Act to provide emergency lead during the pandemic. This law was set to expire in December 2020, but was first extended to March 31, 2021 and then further extended to September 20, 2021.

The Families First Coronavirus Response Act has provided all states with a temporary increase in federal matching funds for Medicaid beneficiaries not in the ACA Medicaid expansion population.