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Topic overview

Starting in the spring of 2020, the number of uninsured Americans began to rise after companies large and small laid off workers during the coronavirus pandemic. With those layoffs, workers lost their employer-sponsored health insurance (ESI). Since then, a number of organizations have estimated the effect of the coronavirus on the unemployment rate.

In August, the Economic Policy Institute, a left-leaning think tank, estimated that 6.2 million Americans lost their ESI. That estimate was based on an analysis of state unemployment claims, EPI said.

Also in August, the Robert Wood Johnson Foundation (RWJF) reported that the Urban Institute estimated a net increase in uninsured Americans of 2.9 million over the last three quarters of 2020 while an earlier model from the Urban Institute estimated an increase in the number of uninsured Americans of between 5.1 million and 8.5 million.

In that same report, RWJF cited an estimate from the Kaiser Family Foundation showing that 27 million Americans would lose employer coverage and be at risk of being uninsured in 2020. KFF also estimated that 80% of those people would be eligible for alternative coverage such as from Medicaid in the 36 states that have expanded their Medicaid programs under the Affordable Care Act.

The problem with all of these estimates, however, is that the extent of economic dislocation from the pandemic is unknown given that the number of infections and deaths continued to rise throughout 2020.

The most accurate assessment of the effect of the pandemic on insurance coverage will have to await the release of the National Health Interview Survey (NHIS) from the federal Centers for Disease Control and Prevention, RWJF concluded.

For a baseline, it would be useful to know pre-pandemic data on the uninsured rate, and there are two good sources of these data. One is the NHIS, as RWJF noted. In June 2020, NHIS reported that from January to June of 2019, 9.5% of all Americans (some 30.7 million people) were uninsured.

Another source of reliable data on the uninsured is the Gallup National Health and Well-Being Index. In January 2019, Gallup said the uninsured rate of 13.7% in the fourth quarter of 2018 was the highest level since the first quarter of 2014. This level was well above the low point of 10.9% recorded in 2016, the last year of the Obama administration.

The highest recent level of uninsured Americans was 18% recorded before the implementation of the Affordable Care Act's individual health insurance mandate in 2014, Gallup added.

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