Trends in US Health Insurance Coverage During the COVID-19 Pandemic

Abstract

Importance: While most working-age adults in the US obtain health insurance through an employer, little is known about the implications of the massive pandemic-related job loss in March 2020 and subsequent rebound for rates of employer-sponsored coverage and uninsurance.

Objective: To determine how health insurance coverage changed during the COVID-19 pandemic.

Design setting and participants: Analysis of trends in insurance coverage based on repeated cross sections of the US Census Bureau's Household Pulse Survey data, using linear regression to adjust for respondent's demographic and socioeconomic characteristics and state of residence. More than 1.2 million US adults aged 18 to 64 years were surveyed from April 23 through December 21, 2020.

Exposures: The COVID-19 pandemic, separated into spring and summer and fall and winter time periods during 2020, as well as state Medicaid expansion status.

Main outcomes and measures: Regression-based estimates of the weekly percentage-point change in respondents' health insurance status, including having any health insurance, any employer-sponsored health insurance, or only nonemployer sponsored coverage. Nonemployer-sponsored coverage is categorized into private, Medicaid, and other public in some analyses.

Results: The study population included 1 212 816 US adults (51% female; mean [SD] age, 42 [13] years) across all 50 US states and Washington DC. Among these respondents, rates of employer-sponsored coverage declined by 0.2 percentage points each week during the COVID-19 pandemic. Other types of coverage, particularly from public sources, increased by 0.1 and 0.2 percentage points in the spring and summer and fall and winter periods, respectively. Overall, health insurance coverage of any type declined, particularly during the spring and summer period, during which uninsurance increased by 1.4 percentage points, representing more than 2.7 million newly uninsured people, over a 12-week period.

Conclusions and relevance: In this cross-sectional study of data from the US Census Bureau's Household Pulse Survey, results showed that while public programs played an important role in protecting US adults from pandemic-driven declines in employment-sponsored coverage, many people became uninsured during 2020.

Figure 1.. Survey Timing and Trends in Unemployment and Insurance Coverage

ESI indicates employer-sponsored insurance.

Figure 2.. Weekly Percentage-Point Change in 2020 Insurance Coverage, Overall and by State Medicaid Expansion Status

Point estimates from regressions are shown, and the error bars indicate 95% CIs. ESI indicates employer-sponsored insurance.

Figure 3.. Weekly Percentage-Point Change in 2020 Insurance Coverage, Overall and by Demographic and Socioeconomic Characteristics

Point estimates from regressions are shown, and the error bars indicate 95% CIs. ESI indicates employer-sponsored insurance.