Millions of Americans lost health insurance coverage at the start of the COVID-19 pandemic

The proportion of Americans without health insurance increased by 1.36 percentage points during the first several weeks of the COVID-19 pandemic, according to findings published in JAMA Health Forum.

This increase represents more than 2.7 million people newly uninsured from April to July 2020, M. Kate Bundorf, PhD, MBA, MPH, a J. Alexander McMahon Distinguished Professor of Health Policy and Management at Duke University, and colleagues reported.

“The results indicate that much of the overall decline in coverage took place within a short 3-month period early in the pandemic,” Bundorf and colleagues wrote. “While employer-sponsored coverage declined throughout 2020, the decline was more fully offset by increases in other sources later in the year.”

In a cross-sectional study, the researchers used data from the U.S. Census Bureau’s Household Pulse Survey to analyze trends in insurance coverage. In total, 1,212,816 million adults aged 18 to 64 years were surveyed from April 23, 2020, to Dec. 21, 2020; 51% were women and the mean age was 42 years. Survey results from April 23 to July 21were classified as the spring and summer period, whereas results from Aug. 19 to Dec. 21 were classified as fall and winter.

The proportion of those with any type of health insurance decreased by 0.11 percentage points weekly during the spring and summer period; this amounted to a 1.36-percentage-point decrease in coverage overall during that period. Also, during this time, employer-sponsored health insurance declined 0.21 percentage points. However, this decline was partially offset by a 0.1-percentage-point increase in other sources of coverage in the spring and summer period and a 0.2-percentage-point increase in the fall and winter period. Overall, during the fall and winter period, the estimated decline in insurance coverage was not statistically significant, according to the researchers.

The increase in those uninsured during the spring and summer was “concentrated in states not expanding Medicaid,” where the weekly rate of decline was 0.23 percentage points, the researchers wrote. During this period, rising rates of uninsurance occurred more frequently among men, adults aged 27 to 50 years, Hispanic individuals and families with low prepandemic income. Enrollment in public health insurance programs increased during the study period, with a large increase in Medicaid enrollment.

“Overall, results of this cross-sectional study indicate that while public programs played an important role in insulating U.S. adults from pandemic-driven declines in [employer-sponsored insurance], many became uninsured,” Bundorf and colleagues wrote. “Monitoring and strengthening the health insurance safety net will continue to be a policy challenge during the COVID-19 pandemic and beyond.”