The Relationship Between Unemployment and Health Insurance Coverage

Abstract

Supplemental Digital Content is available in the text.

Comparison of Unemployment-Related Health Insurance Coverage Changes in Medicaid Expansion vs Nonexpansion States During the COVID-19 Pandemic

“…[17][18][19] This study suggests that new Medicaid enrollment among newly unemployed workers was made more feasible with expanded Medicaid eligibility guidelines during the COVID-19 pandemic. In addition, the results support those of previous studies 5,20 describing the use of broader eligibility guidelines for Medicaid to facilitate unemployment-related Medicaid enrollment during economic downturns (eg, the Great Recession from 2007 to 2009) and the increased accessibility to Medicaid among those affected by local economic downturns after passage of the ACA. In combination with other recent studies, 6,21 we believe that this study's findings provide support for potentially stabilizing access to care through Medicaid expansion for households affected by job loss.…”

“…In addition, the authors found that there was an increase in Medicaid enrollment associated with unemployment in expansion states compared with nonexpansion states. 20 In another study of COVID-19-related Medicaid enrollment in North Carolina, a nonexpansion state, Shafer et al 23 found unemployment-related enrollment to be more prevalent in communities with higher levels of prepandemic social vulnerability (eg, limited access to social services, lower levels of educational attainment, and housing insecurity). The risk of becoming uninsured after job loss was prevalent in both expansion and nonexpansion states.…”

“…The volume of unemployment-related health insurance coverage losses was dependent on whether states had expanded Medicaid programs in place at the time of the downturn. In a related study examining the dynamics between employment, insurance coverage, and Medicaid expansion between 2014 and 2019, Benitez et al found that net coverage losses associated with declining economic conditions largely decreased in states after Medicaid expansion but not in nonexpansion states. In addition, the authors found that there was an increase in Medicaid enrollment associated with unemployment in expansion states compared with nonexpansion states .…”

COVID‐19‐related Medicaid enrollment in Medicaid expansion and non‐expansion states

“…One found Medicaid expansions under the ACA led to increased Medicaid enrollment among the unemployed, and this increased coverage led to stark reductions in uninsurance among this group 26 . Another study found expanding Medicaid's eligibility guidelines increased the connectivity between declines in local economic conditions and Medicaid enrollment 27 . Another study using the HPS found declines in ESI were comparable in expansion and non‐expansion states over time, and non‐expansion states' overall decline in coverage was largely driven by reductions in ESI 28 .…”

“…26 Another study found expanding Medicaid's eligibility guidelines increased the connectivity between declines in local economic conditions and Medicaid enrollment. 27 Another study using the HPS found declines in ESI were comparable in expansion and non‐expansion states over time, and non‐expansion states' overall decline in coverage was largely driven by reductions in ESI. 28 Focusing on trends in COVID‐linked racial disparities in Arkansas, Kentucky, Louisiana, and Texas (non‐expansion state), Figueroa and colleagues found the declines in coverage and access to care were smaller, though not statistically significant, in the three states with expanded Medicaid.…”