Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 3;2(9):e212487.
doi: 10.1001/jamahealthforum.2021.2487. eCollection 2021 Sep.

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

M Kate Bundorf  1   2 , Sumedha Gupta  3 , Christine Kim  4
Affiliations

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

M Kate Bundorf et al. JAMA Health Forum. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Survey Timing and Trends in Unemployment and Insurance Coverage
ESI indicates employer-sponsored insurance.
Figure 2.
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.
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.
See this image and copyright information in PMC

Comment in

References

    1. The employment situation—December 2020. News release. Bureau of Labor Statistics. January 8, 2021. Accessed July 28, 2021. https://www.bls.gov/news.release/archives/empsit_01082021.pdf
    1. Health insurance: tables 2018-forward. US Census Bureau . Accessed July 28, 2021. https://www.census.gov/data/tables/time-series/demo/income-poverty/cps-h...
    1. McIntyre A, Brault MW, Sommers BD. Measuring coverage rates in a pandemic: policy and research challenges. JAMA Health Forum. 2020;1(10):e201278. doi:10.1001/jamahealthforum.2020.1278 - DOI - PubMed
    1. 2020 Household Pulse Survey: interagency federal statistical rapid response survey to measure effects of the coronavirus (COVID-19) pandemic on the United States household population. US Census Bureau . Accessed July 28, 2021. https://www2.census.gov/programs-surveys/demo/technical-documentation/hh...
    1. Rosso RJ. Health insurance continuation coverage under COBRA. Congressional Research Service. June 26, 2020. Accessed July 28, 2021. https://crsreports.congress.gov/product/pdf/R/R40142/21