Even though millions lost their jobs, the uninsured population did not grow over the course of the Covid-19 pandemic, likely due to an increase in public coverage options and subsidies, according to a new report.
The national rate of uninsured individuals has held steady at approximately 11% from 2019 through April of this year.
Between March 2019 and April, the proportion of adults reporting employer-sponsored insurance declined from 65% to 62.3% — a decrease of approximately 5.5 million. In the same time period, the share of adults reporting public coverage increased from 13.6% to 17.5%, an increase of approximately 7.9 million adults.
Published by the Robert Wood Johnson Foundation, the report uses data from the Urban Institute’s Health Reform Monitoring Survey, a nationally representative survey of adults aged 18 to 64. The data includes survey results from March 2019, March/April 2020 and April 2021. About 22,000 people responded to the surveys.
As the Covid-19 pandemic hit, the government put guardrails into place to help prevent coverage losses. Through the Families First Coronavirus Response Act passed last year, Congress put a freeze on disenrollment from Medicaid.
Further, the Biden administration established a special enrollment period to give uninsured Americans a chance to sign up for insurance on the HealthCare.gov markets. As of July 31, 2.5 million Americans have signed up for coverage. Those buying insurance directly from the Affordable Care Act marketplaces also have access to tax credits through the American Rescue Plan Act of 2021.
Though there were gains in public coverage across the country, states that expanded Medicaid saw larger gains than those that did not.
Employer-sponsored insurance coverage declined from 67% in 2019 to 64.6% in 2021 in expansion states. Similarly, it dropped from 61.3% to 57.9% in non-expansion states. While public coverage increased during this period in both groups of states, the jump was larger in expansion states (from 14.9% to 19.2%) as compared with non-expansion states (from 10.7% to 14.3%).
Thus, the uninsured rate varied between expansion and non-expansion states. The —±rate in Medicaid expansion states was approximately 8% between 2019 and 2021. In non-expansion states, the rate was higher in 2021 (18.2%) than in 2020 (16.5%) and 2019 (17.2%).
“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 (which is unlikely to occur before early 2022),” the report authors wrote.
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