How Has the Pandemic Affected Health Coverage in the U.S.?

Written by Daniel McDermottCynthia Cox Robin Rudowitz , and Rachel Garfield and published for on December 9, 2020


Job losses caused by the coronavirus pandemic have threatened to disrupt health coverage for millions of people as most working-age adults get coverage for themselves and their families through their work. Tracking real-time changes in coverage and the uninsured rate is difficult to do with much precision because the large national surveys that produce these estimates lag by months or years, and private surveys generally lack sufficient sample to measure coverage changes precisely. Many real-time surveys have faced challenges of high rates of survey nonresponse (not responding to the survey or particular questions) particularly among populations most likely affected by the economic downturn, including the Census Bureau’s Household Pulse Survey. However, various sources of administrative data allow us to piece together what might be happening to health coverage rates amid the pandemic.

Declines in employer sponsored insurance are far less than overall declines in employment.  First, using administrative data insurers file with state regulators (compiled by Mark Farrah Associates TM), we can see how enrollment in employer plans has changed through the end of September. Although employment rates fell by 6.2% from March to September, enrollment in the fully-insured group market decreased by just 1.5% over the same period.

If we extrapolate this finding to the entire group market, including self-insured employer plans, this would suggest that a total of roughly 2 to 3 million people may have lost employer-based coverage between March and September. To be very clear, this is only a rough estimate. We do not have reliable data for self-insured employers (which insure about 6 in 10 people with employer coverage and tend to be larger), and those employers may have made different decisions than fully-insured employers did about layoffs and whether and how to maintain coverage for employees.