Insurance Loss: Millions Uncovered

Millions of people have lost their health insurance in recent years, with the coronavirus pandemic and resulting unemployment playing a significant role. In the US, an estimated 27 million people lost their health insurance, which is primarily provided through their jobs. This situation was further exacerbated by the challenges of obtaining new coverage, with many individuals facing obstacles such as complicated processes and high costs. The loss of insurance disproportionately affected individuals from low-income families, people of colour, and nonelderly adults.

How many people lost insurance during the pandemic

The COVID-19 pandemic has resulted in a significant number of people losing their insurance. In the United States, the primary source of health insurance coverage for working-age adults is through their employer, so the pandemic-induced job losses meant a loss of income as well as health insurance for millions.

Estimates vary on the number of people who lost their insurance during the pandemic. By June 2020, as many as 7.7 million workers had lost their jobs with employer-sponsored insurance, affecting a total of 14.6 million individuals when taking into account the 6.9 million dependents covered by these plans. However, other estimates place the number higher, with one study by the Economic Policy Institute suggesting that 16.2 million workers lost their insurance as of May 2020. A separate study by Families USA found that 5.4 million workers lost their insurance between February and May, while another analysis by the Urban Institute and the Robert Wood Johnson Foundation projected that 10.1 million people would no longer have employer-sponsored insurance by the end of 2020.

The discrepancy in the estimates can be attributed to the complex nature of insurance coverage and job losses. For instance, some workers who lost their jobs with insurance were temporarily laid off or furloughed and were able to retain their insurance coverage through their employer. Additionally, those who lost their insurance had alternative options to gain coverage, such as enrolling in government health insurance programs or switching to a family member's plan. Despite these alternatives, the loss of insurance for millions of people during a global pandemic had far-reaching consequences, especially with the high costs associated with COVID-19 treatment.

The impact of the pandemic on insurance coverage also varied across different groups. For instance, the initial decline in coverage was concentrated among men, people aged 27 to 50, Hispanics, and low-income families. Furthermore, certain industries, such as accommodation and food services, were disproportionately affected by job losses, which also resulted in a loss of insurance for many workers.

While the exact number of people who lost insurance during the pandemic may not be known until official data is released, the estimates highlight the vulnerability of millions of people to losing their health coverage in times of economic crisis.

How many people lost insurance due to unemployment

The COVID-19 pandemic has resulted in a massive increase in unemployment, which peaked at 14.7% in April 2020. During the 15 weeks from mid-March to the end of June that year, Americans filed nearly 49 million new claims for unemployment benefits.

Most people in the US get their health insurance through their jobs. Therefore, it is no surprise that the surge in unemployment also led to a significant number of people losing their health insurance.

A report from the Kaiser Family Foundation estimated that 27 million people lost their health insurance, while the Economic Policy Institute put this figure at 16.2 million as of May 2020. A more conservative estimate by the Commonwealth Fund put the number at 7.7 million workers, whose insurance also covered 6.9 million dependents, bringing the total number of affected individuals to 14.6 million.

The Commonwealth Fund survey also suggested that perhaps only half of these individuals would lose their insurance, a conclusion supported by a July 2020 Urban Institute report, which found that only about a third of those who lose insurance through job loss will become uninsured. A more recent estimate by the BlueCross BlueShield Association found that only 3.1 million people lost their insurance between March and September.

The path from job loss to loss of health insurance is not straightforward and depends on several factors, including whether the job loss is temporary or permanent, and whether the employer continues health insurance coverage until the worker returns to their job.

How many people can't afford insurance

The high cost of health insurance in the US is a burden on many families, with nearly one-third of Americans facing each day without the security of knowing that medical care is available to them and their families. According to a 2022 survey by the Commonwealth Fund, a private research foundation, 43% of working-age adults were inadequately insured. This means that they were either uninsured (9%), had a gap in coverage over the previous year (11%), or were insured all year but were underinsured (23%)—defined as having coverage that didn't provide affordable access to healthcare.

The number of uninsured Americans dropped from 27.5 million in 2021 to 25.6 million in 2022, a record low. However, this still means that about 44 million people in the US have no health insurance, and another 38 million are underinsured.

Who Are the Uninsured?

The uninsured are disproportionately young, Latino, low-income, and living in the South. Most uninsured individuals are adults in working low-income families and are people of color. Reflecting geographic variation in income and the availability of public coverage, most uninsured people live in the South or West.

Despite policy efforts to improve the affordability of coverage, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2022, 64% of uninsured non-elderly adults said that they were uninsured because the cost of coverage was too high. Many uninsured people do not have access to coverage through their jobs, and some, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance. Additionally, undocumented immigrants are ineligible for federally funded coverage.

The Impact of Being Uninsured

People without insurance coverage have lower access to care than those who are insured. They are more likely to delay or forgo care due to costs, and are less likely to receive preventive care and services for major health conditions and chronic diseases. Uninsured individuals often face unaffordable medical bills when they do seek care, which can quickly lead to medical debt, as most uninsured people have low or moderate incomes and little to no savings.

The Impact of Underinsurance

Even those with health insurance may struggle with the burden of healthcare costs. About half of insured adults worry about affording their monthly health insurance premiums, and large shares of adults with employer-sponsored insurance rate their insurance as "fair" or "poor" when it comes to monthly premiums and out-of-pocket costs. More than four in ten people who obtained individual health plans for 2022, including those purchasing plans on the Affordable Care Act marketplaces, were underinsured. The survey also found that nearly 30% of those in employer-sponsored health plans fell into the same category.

Steps Towards Improvement

Health policy analysts suggest that Congress and the states can take further steps to increase insurance coverage and protect patients' financial security. One of the most effective ways to improve inadequate health insurance would be for the 12 holdout states to expand Medicaid eligibility as allowed under the Affordable Care Act. This step alone could bring insurance coverage to 3.7 million more people.

Additionally, the recently passed federal Inflation Reduction Act extended pandemic-era subsidies for marketplace health insurance plans for another three years, which will help many people afford premiums. However, enrollment in health coverage is likely to drop when the COVID-19 public health emergency ends, as the moratorium on disenrolling Medicaid beneficiaries will also end.

How many people lost insurance under Obamacare/ACA

The Affordable Care Act (ACA), commonly referred to as Obamacare, caused a significant shift in the US healthcare system when it was signed into law by President Barack Obama in 2010. One of the most controversial aspects of the ACA was the potential impact on citizens' existing insurance plans. Despite assurances from Obama that those who liked their current insurance plans would be able to keep them, it became clear that this would not be the case for everyone.

In October 2013, many Americans who had purchased insurance through the individual market began to receive letters notifying them that their current plans would be cancelled by the end of the policy term. These plans, which covered millions of people, were discontinued because they did not meet the new minimum coverage requirements set by the ACA. While policyholders were not denied the ability to obtain insurance, the cancellation of their existing plans caused concern and uncertainty for many.

Estimates vary regarding the exact number of people whose insurance plans were cancelled due to the ACA. The most commonly cited figure is 4.7 million, based on reporting by the Associated Press in December 2013. However, there have been questions about the accuracy of this number, and subsequent analyses have suggested a lower figure of around 2.6 million.

It is important to note that those whose plans were cancelled were offered alternative options. They could shop for new insurance plans on federal and state marketplaces or through brokers or insurance carriers. Additionally, many individuals were likely eligible for federal subsidies to help with the cost of insurance, potentially resulting in better coverage and lower rates.

While the ACA led to insurance plan cancellations for some, it is worth considering the broader impact of the law on insurance coverage. According to the Department of Health and Human Services (HHS), as of early 2023, more than 40 million Americans have gained coverage under the ACA, the highest total on record. This includes a significant reduction in the number of uninsured individuals, with the uninsured rate approaching an all-time low by the end of 2021.

In summary, while it is difficult to pinpoint the exact number, it is clear that millions of people lost their existing insurance plans due to the implementation of the ACA. However, the law has also led to a net increase in insurance coverage, with many individuals gaining access to healthcare who may not have had it previously.

How many people lost insurance due to immigration status

Undocumented immigrants are more likely to lose insurance compared to native-born citizens. Legal residents are also slightly more likely to lose insurance than native-born citizens. Naturalized citizens, however, do not differ from native-born citizens in terms of insurance loss.

As of 2023, half of undocumented immigrants and one-fifth of legal residents reported being uninsured, compared to less than one-tenth of naturalized and native-born citizens.

In 2022, there were about 45.5 million immigrants residing in the US, including 21.2 million non-citizens and 24.2 million naturalized citizens, each accounting for about 7% of the total population. About 60% of non-citizens were legal residents, while the remaining 40% were undocumented.

Undocumented immigrants are not eligible for federally funded coverage programs such as Medicaid, CHIP, or Medicare, nor can they purchase coverage through the ACA Marketplaces.

However, some states have expanded access to health coverage for immigrants. As of March 2024, 12 states and Washington, D.C., provided comprehensive state-funded coverage for children regardless of immigration status. By 2025, two more states plan to offer similar coverage.

Additionally, six states and Washington, D.C., have expanded fully state-funded coverage to some income-eligible adults, regardless of immigration status. Other states cover specific groups, such as legal residents in the five-year waiting period for Medicaid, or provide more limited benefits.

Enrollment in these state-funded programs could nearly double by 2025, as at least seven states initiate or expand coverage.

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