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

This cross-sectional study seeks to determine how health insurance coverage changed in the US during the COVID-19 pandemic. Question How did health insurance coverage change during the COVID-19 pandemic? Findings In this cross-sectional survey study of more than 1.2 million US adults, rates of employer-sponsored coverage declined and rates of other types of coverage increased after the pandemic began and throughout 2020. Rates of uninsurance increased, particularly during the spring and summer. Meaning While public programs played an important role in protecting US adults from pandemic-driven declines in employer-sponsored coverage, many people became uninsured during the pandemic. 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.

Automated summary

During the COVID-19 pandemic in the US, employer-sponsored coverage declined while other types of coverage increased, leading to an overall decline in health insurance coverage. Public programs helped protect adults from declines in employer-sponsored coverage, but many people became uninsured during the pandemic.