Urban Institute: Medicaid expansion will be a critical safety net as COVID-19 job losses continue nationwide 

Experts say Medicaid expansion will be a critical safety net for people who lose their jobs due to COVID-19. (Getty/designer491)

As more Americans lose their jobs amid orders from public health officials to stay home to prevent the spread of COVID-19, the number of people without health insurance is also expected to rise. 

To paint a picture of what that might look like, researchers at the Urban Institute, a left-leaning think tank, used data from the Great Recession that began in 2008 and weighed the impact of coverage expansions under the Affordable Care Act (ACA).

Nearly a quarter of unemployed adults were also uninsured between 2008 and 2013. That number declined to about 18% in 2014 following the full implementation of the ACA, due in large part to Medicaid expansion.

Uninsured rates among people who were unemployed did decline across states that either did or did not expand Medicaid, but the decreases were far larger in expansion states, according to the report. In expansion states, the number of uninsured and unemployed adults dropped by 46%, while that number declined by 21% in non-expansion states.

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Between 2014 and 2018, unemployed people were likely to enroll in Medicaid in expansion states, with about 36% covered by the program. By contrast, adults in non-expansion were most likely to be uninsured, with about 43% of unemployed people in those states going without coverage. 

“The ACA created an important safety net, so that losing your job doesn’t mean that you have to lose your coverage,” said Kathy Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, which backed the study, in a statement. 

“In these very challenging times, we need to pull out all the stops and use every policy tool at our disposal to keep people connected to coverage even as millions will likely lose their jobs and become uninsured,” she said. 

What do all these stats mean for the current COVID-19 crisis? For one, Medicaid expansion states should brace for a potentially large influx of people enrolling in the program as they lose their jobs. 

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In addition, non-expansion states should expect to see the number of uninsured rise with the unemployment rate—a high-risk situation in the midst of a pandemic, the researchers warn. Steps that could mitigate this include temporary or speedy Medicaid expansions in these states or expanding the subsidy range for people seeking coverage on the ACA’s exchanges. 

Also of concern is the looming Texas v. Azar case, which the Supreme Court is set to consider later this year, which could overturn the ACA, the researchers said. 

“As experts predict unprecedented unemployment rates because of COVID-19’s economic consequences, reversing the ACA, and thereby strengthening the relationship between joblessness and lack of health insurance coverage, would counteract efforts to contain the virus, improve public health, and stabilize the economy,” the authors wrote.