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July 7, 2020

More US Adults Report Insurance Coverage Loss Associated With COVID-19 Recession

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2020;1(7):e200855. doi:10.1001/jamahealthforum.2020.0855

More than 2 of 5 US workers who have experienced job loss or a furlough because of the coronavirus disease 2019 (COVID-19) pandemic and struggling economy—or whose spouse or partner experienced such employment disruption—relied on that job for health insurance. Many of those workers have been left without insurance and unable to obtain alternative coverage.

These findings have been revealed in a new report from the Commonwealth Fund, an early look at the outcomes on the COVID-19 pandemic on health insurance coverage. The report is based on a nationally representative telephone survey of 2271 adults 18 years or older conducted from May 13 through June 2, 2020.

Twenty-one million people were unemployed in May 2020, according to the US Department of Labor. The Kaiser Family Foundation estimated in mid-May that 47.5 million people in the US were at risk of losing employer-sponsored insurance because of the tsunami of job losses over the previous 2 months.

According to a 2019 report from the Congressional Budget Office, more than half of US adults depended on their employer or a family member’s employer for their health insurance. The pandemic has upended that relationship.

The Commonwealth Fund report found that 41% of adults who experienced job loss or furlough (or whose spouse or partner did so) because of the pandemic had employer-based health insurance coverage through the affected job. Although some of these individuals were able to retain their job-based insurance or an alternative, 1 in 5 lost insurance coverage.

“This survey shows how our piecemeal approach to health insurance coverage in the US leaves too many people without coverage or just a layoff away from losing it,” said Sara Collins, PhD, lead author of the study and Commonwealth Fund Vice President for Health Care Coverage and Access, in a statement. “Here in the fourth month of COVID-19 related job losses, a growing number of people won’t be able to afford health care in the midst of the worst public health crisis in modern times.”

The research, conducted by the Commonwealth Fund and the survey research firm SSRS, found that many workers experiencing furloughs were able to continue coverage. More than half of respondents (53%) who said they or their spouse or partner (or both) had coverage through an affected job also said at least 1 of them was still covered through an employer health plan during a furlough.

“In our survey, the large share of respondents who said they or a spouse or partner were still getting coverage through a furloughed job accounted for the relative stability of insurance coverage in the findings,” the authors noted. “Whether those on furlough regain their jobs, or lose them permanently, will determine the longer-term effect of the pandemic on employer-based coverage.”

Another 14% said that they, their partner or spouse, or both had gained coverage through the employer of the spouse or partner. Another 10% had coverage or were planning to get covered through the Consolidated Omnibus Budget Reconciliation Act (COBRA), and 7% said at least 1 person had enrolled in Medicaid or an individual-market plan. The survey also found the highest rates of furloughs and layoffs among Hispanic workers and workers with lower incomes (less than $50 000 per year). Approximately 31% of Hispanic survey respondents reported job disruption, compared with 18% of White respondents, and 21% of people with annual incomes less than $50 000 reported layoffs or furloughs, compared with 16% of workers with an annual income of $50 000 or higher.

The researchers also asked survey participants about whether they thought that people who obtain their health insurance through an employer should have the option of similar coverage at a similar cost through government-regulated and government-subsidized health plans they could buy on their own. Nearly three-quarters of respondents (74%) supported such an option.

The report’s authors noted that several policy options could help widen access to coverage for workers and their families, such as aggressive outreach efforts to alert workers who have lost employer-based coverage that they might be eligible for subsidized coverage through Medicaid or marketplaces established by the Affordable Care Act, simplifying documentation requirements for marketplace special enrollment periods, enhancing and extending subsidies higher up the scale in the marketplaces to make premiums more affordable, or offering individuals with job-based insurance the option to buy coverage in a health plan regulated and subsidized by the government. Other policy options included expanding Medicaid without restrictions in states that have not yet done so or creating a federal solution for individuals who continue to lack access to coverage in those states.

The authors also noted that the survey shows that about 1 in 3 people who lost jobs already lacked insurance before the pandemic. “This points to the lingering gaps in our insurance system, driven by a lack of Medicaid expansion in 14 states; affordability barriers in buying coverage through the marketplaces; lack of awareness of coverage options, exacerbated by the Trump administration’s pull-back of advertising and general support for the ACA; and that undocumented immigrants are ineligible for subsidized coverage,” they wrote. “Our findings suggest that the pandemic is likely increasing the number of people who are uninsured.”

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