Uninsurance rates remain fixed during pandemic thanks to public safety nets

Photo: PhotoAlto/Frederic Cirou/Getty Images

Last April, when the national unemployment rate reached 14.7% – the highest rate and the largest month-over-month increase in the history of the Bureau of Labor Statistics – many feared for how that would affect health coverage for those unemployed individuals.

A recently published report from the Urban Institute suggests that despite the economic fallout caused by COVID-19, the national uninsurance rate held steady at about 11% during the pandemic, thanks in large part to the public safety net provided by the Affordable Care Act.

"Unlike the last recession, losses in employer-sponsored insurance during the pandemic did not lead to growth in the number of uninsured," Michael Karpman, senior research associate at the Urban Institute, said in a statement.

"Medicaid and the health insurance Marketplaces provided many people with a safety net that allowed them to maintain coverage during difficult times."

The results are based on the Urban Institute's Health Reform Monitoring Survey, which included adults aged 18 to 64 across the country, and was conducted in March 2019, March and April 2020, and April 2021.

WHAT'S THE IMPACT?

During the survey period, the percentage of adults with employer-sponsored health insurance declined from 65% to 62.3%, representing roughly 5.5 million individuals.

Those losses were offset by increases in public coverage enrollment, which went from 13.6% to 17.5% over the same time frame – an increase of approximately 7.9 million adults.

This growth can be attributed to expanded Medicaid eligibility under the ACA in 37 states and the District of Columbia, the Families First Coronavirus Response Act's Medicaid disenrollment freeze and historic trends of increased Medicaid enrollment during recessions, according to the report.

Public coverage increased across the nation, but the largest gains were in states that expanded access to Medicaid. In expansion states, the share of adults enrolled in public health insurance went from 14.9% to 19.2%, compared to nonexpansion states where enrollment increased from 10.7% to 14.3%.

Although the national uninsurance rate remained steady during this period, the uninsurance rate in nonexpansion states was more than double that in expansion states (18.2% versus 7.7%). That was disproportionately felt by low-income folks, of which 37.7% were uninsured in nonexpansion states compared to 14.5% in expansion states.

"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," Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in a statement.

"The enhanced safety net provided by the ACA was critical in keeping people covered, especially in states that expanded Medicaid."

As the nation continues to recover from the height of the pandemic, the researchers stress the need to protect coverage for the most vulnerable populations. They recommend creating outreach campaigns to help people transition from Medicaid to Marketplace coverage, policy changes to incentivize states to expand their Medicaid eligibility, and making improvements to the ACA.

THE LARGER TREND

The Biden Administration has already taken several steps to ensure people have access to healthcare coverage. In January, he opened a special enrollment period (SEP) to the ACA, which intends to make health insurance available for those who lost their coverage, along with their jobs, during the coronavirus pandemic.

The SEP originally ran from February 15 through May 15, but was extended until August 15. More than 2.5 million Americans had signed up for health coverage through the ACA as of July 31, according to the Centers for Medicare and Medicaid Services.

Enrollment in Medicaid and CHIP has also increased during the pandemic. Between February 2020 and January 2021, there was a 13.9% increase in people who enrolled in coverage, representing about 9.9 million people, according to CMS.

Based on the demand for public coverage options, CMS recently proposed making changes to the ACA's exchanges next year. The proposal would lengthen the annual open enrollment period by an additional 30 days, create a new special enrollment period opportunity for low-income consumers, and expand the duties of Federally-facilitated Exchange Navigators to offer additional help to consumers enrolling in plans.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org