Aug 23, 2021 - Health

U.S. uninsurance rate unchanged during pandemic despite layoffs

Illustration of a health plus in front of a criss-cross pattern surrounded by smaller plusses.

Illustration: Aïda Amer/Axios

Despite layoffs, losses of income and employer-backed insurance during the pandemic, the uninsurance rate did not change between March 2019 and April 2021 thanks to increased enrollment in public coverage, according to a new report out today by the Urban Institute.

But, but, but: More than one in 10 adults (11%) overall were still uninsured in April 2021, including nearly 20% of adults in states that have not expanded Medicaid.

Why it matters: This lack of change in the insurance rate during the pandemic is unlike previous recessions, the report says.

By the numbers: Public coverage gains occurred in states with and without Medicaid expansion. Still, the declines in employer-based insurance and increases in public coverage between 2019 and 2021 were mostly among adults under 65 with low and moderate incomes.

  • The number of adults younger than 65 with employer-sponsored insurance coverage dropped from 65% to 62.3%, or a drop of about 5.5 million adults, between March 2019 and April 2021.
  • The uninsured rate in states without Medicaid expansion was more than double expansion states in April 2021, at about 18% and 8%, respectively.

State of play: Researchers say several factors from public insurance helped offset the employer insurance losses:

  1. Expanded Medicaid eligibility under the Affordable Care Act in 37 states and Washington D.C.
  2. Paused Medicaid disenrollment under the Families First Coronavirus Response Act in 2020.
  3. An overall rise in Medicaid enrollment during previous recessions.

What to watch: "Maintaining the current uninsurance rate will require protecting coverage for current and prospective Medicaid enrollees as the economy improves and the disenrollment freeze is lifted," the authors write.

Methodology: The brief had approximately 9,000 to 9,500 adults participants in each online survey round, ages 18 to 64, in March 2019, March/April 2020, and April 2021.

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