Changes in US Medicaid Enrollment During the COVID-19 Pandemic

Bhanja, Aditi; Sommers, Benjamin D.

doi:10.1001/jamanetworkopen.2021.9463

Cited by 39 publications

(38 citation statements)

References 4 publications

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“…A large increase in Medicaid enrollment was consistent with documentation of rising Medicaid enrollment during the pandemic, as well as prepandemic evidence that the ACA’s new coverage options have alleviated the negative effect of unemployment on insurance coverage. 17 , 18 , 19 The increase in public coverage may also be because of provisions of the Families First Coronavirus Response Act, which prevented states from terminating Medicaid coverage during the pandemic. 20 In other words, rising rates of Medicaid coverage in both expansion and nonexpansion states may have been driven in part by declining disenrollment due to this policy.…”

Section: Discussionmentioning

confidence: 99%

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

2021

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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. OBJECTIVETo 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 employersponsored health insurance, or only nonemployer sponsored coverage. Nonemployer-sponsored coverage is categorized into private, Medicaid, and other public in some analyses. RESULTSThe 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 employersponsored 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 RELEVANCEIn 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.

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Section: Discussionmentioning

confidence: 99%

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

2021

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“…While many states implemented strategies and policies during the pandemic to simplify the eligibility and enrollment process, early evidence suggests that these have had little to no effect in improving Medicaid enrollment. 18 – 20 One potential strategy to protect people from uninsurance is to promote automatic enrollment for eligible individuals as they exit the employer-based coverage system if a no premium plan exists. State unemployment insurance agencies, for example, can help eligible, newly unemployed people automatically enroll in the ACA exchanges or Medicaid.…”

Section: Discussionmentioning

confidence: 99%

Changes in Employment Status and Access to Care During COVID-19 Pandemic Among Low-Income Adults in 4 Southern States

et al. 2022

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Background While the impact of the COVID-19 recession on the economy is clear, there is limited evidence on how the COVID-19 pandemic-related job losses among low-income people may have affected their access to health care. Objective To determine the association of job loss during the pandemic with insurance coverage and access to and affordability of health care among low-income adults. Design Using a random digit dialing telephone survey from October 2020 to December 2020 of low-income adults in 4 states—Arkansas, Kentucky, Louisiana, and Texas—we conducted a series of multivariable logistic regression analyses, adjusting for demographics, chronic conditions, and state of residence. Participants US citizens aged 19–64 with a family income less than 138% of the federal poverty line who became newly unemployed during pandemic, remained employed during pandemic, or were chronically unemployed before and during the pandemic. Main Measures Rates of insurance, type of insurance coverage, measures of access to/affordability of care, and food/housing security Key Results Of 1,794 respondents, 14.5% were newly unemployed, 49.6% were chronically unemployed, and 35.7% were employed. The newly unemployed were slightly younger and more likely Black or Latino. The newly unemployed were more likely to report uninsurance compared to the employed (+16.4 percentage points, 95% CI 6.0–26.9), and the chronically unemployed (+26.4 percentage points, 95% CI 16.2–36.6), mostly driven by Texas’ populations. The newly unemployed also reported lower rates of access to care and higher rates of financial barriers to care. They were also more likely to report food and housing insecurity compared to others. Conclusions In a survey of 4 Southern States during pandemic, the newly unemployed had higher rates of uninsurance and worse access to care—largely due to financial barriers—and reported more housing and food insecurity than other groups. Our study highlights the vulnerability of low-income populations who experienced a job loss, especially in Texas, which did not expand Medicaid. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07547-9.

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“…Although we cannot identify coverage source in BRFSS, our results also comport with estimates from the National Health Interview Survey, 20 the Current Population Survey, 21 the Survey of Income and Program Participation, 22 and the Health Reform Monitoring Survey, 11 which all suggest that gains in public coverage may have offset losses in private coverage. 8 , 23 Thus, we have good reason to believe uninsurance and lack of health care access was prevented for some individuals because of Medicaid expansion. All states participated in the “maintenance of effort” provisions in the Coronavirus Aid, Relief, and Economic Security Act, which offered an enhanced federal match rate to states that facilitated continuous Medicaid coverage for beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

et al. 2022

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Background: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities. Objective: To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status. Research Design: We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends. Subjects: Data were extracted for all adults aged 18–64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System (N=1,731,699) from all 50 states and the District of Columbia. Measures: Our outcomes included indicators for whether respondents had any health insurance coverage or avoided seeking care because of cost within the prior year. The primary exposure was the onset of the COVID-19 pandemic in the United States in March 2020. Results: The pandemic was associated with a 1.2 percentage point (pp) decline in uninsurance for Medicaid expansion states (95% CI, −1.8, −0.6); these reductions were concentrated among respondents who were Black, multiracial, or low income. The rates of uninsurance were generally stable in nonexpansion states. The rates of avoided care because of cost fell by 3.5 pp in Medicaid expansion states (95% CI, −3.9, −3.1), and by 3.6 pp (95% CI, 4.3–2.9) in nonexpansion states. These declines were concentrated among respondents who were Hispanic, Other Race, or low income. Conclusions: Our findings reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations.

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Changes in US Medicaid Enrollment During the COVID-19 Pandemic

Abstract: This cross-sectional study analyzes changes in Medicaid enrollment for all 50 US states and Washington, DC, during the first 9 months of 2020, at the beginning of the COVID-19 pandemic.

Cited by 39 publications

References 4 publications

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

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

Changes in Employment Status and Access to Care During COVID-19 Pandemic Among Low-Income Adults in 4 Southern States

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

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