Number of uninsured adults steady despite impact from COVID-19 pandemic: analysis

Health insurance form payer plan enroll
The Affordable Care Act and Medicaid helped blunt a decline in employer-sponsored plans spurred by the pandemic, a new analysis finds. (Valeriya/Getty)

The percentage of U.S. adults without insurance held steady at 11% despite the COVID-19 pandemic, a new analysis finds.

The analysis, released Monday by the Robert Wood Johnson Foundation, discovered that while employer-sponsored insurance declined from March 2019 to April 2021, government programs blunted a sharp decline in the uninsured rate.

“Those who suffered the most from the economic fallout associated with COVID were low-wage workers, so the loss of job-related coverage was less than in previous recessions,” said Katherine Hempstead, senior policy adviser with the Robert Wood Johnson Foundation, in a statement Monday.

Adults reporting employer-sponsored coverage declined from 65% to 62.3% over the course of the time frame, a decline of 5.5 million people. Meanwhile, nearly 8 million people got coverage from government programs such as Medicaid or the Affordable Care Act’s (ACA's) insurance exchanges.

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Government program coverage gains occurred even in states that did not expand Medicaid under the ACA. So far, a dozen states have not expanded Medicaid.

The Biden administration has sought to make it easier for the holdout states to expand Medicaid. The American Rescue Plan Act increased by five percentage points the federal matching Medicaid rate for newly expanded states. Democrats are also likely to include legislation to close a Medicaid coverage gap in non-expansion states as part of a $3.5 trillion infrastructure package.

Adults reporting government coverage in expansion states increased from nearly 15% to 19.2%. Adults getting government coverage in non-expansion states also increased from 10.7% to 14.3%.

“Medicaid and the health insurance marketplaces provided many people with a safety net that allowed them to maintain coverage during difficult times,” said Michael Karpman, senior research associate with the think tank Urban Institute, which conducted the study.

The Biden administration created a special enrollment period for the ACA's exchanges to help people affected by the pandemic enroll in marketplace coverage. 

The study, which relies on a monitoring survey conducted by Urban of 9,000 to 9,500 adults, is the latest to show major gains in enrollment in government programs due to the pandemic.

A June report from the Centers for Medicare & Medicaid Services found that nearly 9.9 million people enrolled in Medicaid and the Children’s Health Insurance Program over the past year, a nearly 14% increase.