Abstract
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. To determine how health insurance coverage changed during the COVID-19 pandemic. 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. The COVID-19 pandemic, separated into spring and summer and fall and winter time periods during 2020, as well as state Medicaid expansion status. 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. 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. 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.
Highlights
The COVID-19 pandemic has placed millions of workers at risk of uninsurance
Rates of employersponsored coverage declined by 0.2 percentage points each week during the COVID-19 pandemic
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
Summary
The COVID-19 pandemic has placed millions of workers at risk of uninsurance. The pandemic’s onset was accompanied by an unprecedentedly large, swift decline in employment, with the unemployment rate peaking at 14.7% in April 2020 and steadily declining to 6.7% in December 2020. The extent of uninsurance during the COVID-19 recession, is largely unknown, primarily owing to a lack of comprehensive, real-time data on coverage.[3] Yet, this recession differed in important ways from earlier economic downturns, including the swiftness of the initial economic decline and the sensitivity of the recovery to both policy and the epidemiology of COVID-19. We addressed this gap by analyzing the 2020 Household Pulse Survey (HPS),[4] a US Census Bureau experimental data product intended to provide timely information on the pandemic’s effect on US households. While the HPS has limitations, primarily owing to its low response rate and its lag in data collection relative to the large, initial decline in employment, with 40 000 to 130 000 respondents per week it is perhaps the only source of information on trends in health insurance coverage during the pandemic from a large population-based sample
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