States Facing COVID-19 Spikes Report Greatest Health Insurance Coverage Losses

Job losses between February and May 2020 due to the coronavirus disease 2019 (COVID-19) pandemic resulted in 5.4 million Americans losing their health insurance, according to a recent report from Families USA.

The pandemic and subsequent economic downturn led to a 3-month increase in uninsured adults 39% higher than any annual increase ever recorded. In comparison, 3.9 million nonelderly (under 65 years) adults lost insurance coverage during the Great Recession between 2008 and 2009, the highest previous increase in insurance loss.

Current numbers show that across the country 16% of US adults, or 1 in 7, lack health care insurance. However, complete 2020 data will not become available until 2021, after the federal government publishes its health insurance estimates for the previous year.

Researchers used data from the US Bureau of Labor Statistics to assess changes in the number of unemployed workers outside the labor force in each state. They then applied these numbers to research findings on coverage from the Urban Institute, which show the percentage of unemployed workers who became uninsured since the main coverage provisions of the Affordable Care Act (ACA) took effect in 2014.

Authors note legislation making a serious effort to protect comprehensive health insurance in the wake of the pandemic has yet to be signed into law. “Policymakers need to know now about the magnitude of coverage losses as they decide whether and, if so, how the next COVID-19 legislation will restore and maintain comprehensive health insurance,” they write.

As of May 2020, the states with the greatest percentage of nonelderly adults currently uninsured include Texas (29%), Florida (25%), Nevada (21%), Oklahoma (24%), Mississippi (22%), Georgia (23%), South Carolina (20%), and North Carolina (20%). Nearly half (46%) of the increases in the uninsured occurred in just 5 states: California, Texas, Florida, New York, and North Carolina.

In addition, Florida, Texas, Oklahoma, Mississippi, North Carolina, South Carolina, and Georgia are among the states reporting the highest numbers of new COVID-19 cases per 100,000 residents, as of July 12.

“We knew these numbers would be big,” said Stan Dorn, director of Families USA’s National Center for Coverage Innovation. “This is the worst economic downturn since World War II. It dwarfs the Great Recession. So it’s not surprising that we would also see the worst increase in the uninsured.”

However, the data only accounted for individuals who lost insurance as a result of job loss and excluded any family members previously covered by the plans.

The 5 states that experienced increases in the number of uninsured adults greater than 40% include Massachusetts, where the number nearly doubled, rising by 93%; Hawaii (72%); Rhode Island (55%); Michigan (46%); and New Hampshire (43%).

Of all the newly uninsured individuals, the majority (63%) live in 10 states: California, Texas, Florida, New York, North Carolina, Michigan, Illinois, Georgia, Massachusetts, and Ohio.

When it comes to Medicaid expansion, data show that states who adopted this measure of the ACA tended to report lower uninsured rates. Florida, Georgia, Mississippi, North Carolina, South Carolina, and Texas are among the 13 states that have not adopted Medicaid expansion; on average, 22.6% of unemployed workers become uninsured in states that did expand Medicaid, compared with 42.5% in states that did not.

Financial cuts imposed by the Trump administration to outreach programs, which helped individuals sign up for a marketplace plan in states that did not expand Medicaid, have also reduced awareness among unemployed individuals, potentially limiting them to available options.

In addition, in June, the Trump administration and Republican state attorneys general called on the Supreme Court to overturn the entire ACA, a move criticized by Democrats and proponents of the law.

“President Trump and the Republicans’ campaign to rip away the protections and benefits of the Affordable Care Act in the middle of the coronavirus crisis is an act of unfathomable cruelty,” said House Speaker Nancy Pelosi, D-California.

As the health insurance law is expected to be a contested topic in the 2020 presidential election, the Supreme Court is likely to hear the case after a new president takes office.

Authors stress high rates of individuals without health insurance “is particularly problematic during a pandemic involving a highly infectious, deadly disease, especially in states that are allowing residents to be in closer personal contact by attempting to reopen their economies — often the same states that are now experiencing significant spikes in COVID-19 infection rates.”

Any delays in diagnosis and treatment resulting from lack of insurance could endanger both the individuals and their communities. Conditions such as cancer and heart disease “are more likely to worsen until hospitalization is required or treatment becomes ineffective,” authors write. They continue, “losing health insurance thus makes permanent health problems — and even early death — significantly more likely for conditions unrelated to COVID-19.”

Some families may be faced with the decision of paying for essential medical care out of pocket or meeting other basic human needs.

Two bills, the Health Economic Recovery Omnibus Emergency Solutions Act (HEROES Act) and the Patient Protection and Affordable Care Enhancement Act, recently passed by House Democrats, would fully subsidize health plans for laid-off and furloughed workers and incentivize states to expand Medicaid. However, they are unlikely to move forward due to the Republican-controlled Senate.

To address these coverage losses, authors urge Congress to protect comprehensive health insurance coverage, arguing the next economic aid package should include:

• Full COBRA subsidies
• Increased premium tax credits for low- and moderate-income consumers
• $600 million in annual funding for consumer assistance
• A special enrollment period that lets uninsured families quickly obtain private health coverage through the federal health insurance exchange
• A substantial boost to federal matching funds for state Medicaid programs, with accompanying guardrails to maintain coverage

Encouraging the president to better promote the special enrollment period provision of the ACA, and to aid laid-off workers in maintaining their coverage through COBRA, Senator Patty Murray, D-Washington, said, “Taking steps like these…shouldn’t be controversial, it should be common sense, and we should be doing it right now instead of waiting for things to get even worse.”