By Suzanne Wikle

Census data show that one million people lost health insurance in 2019, including more than 300,000 children. Those most likely to be uninsured were Black or Hispanic, reflecting systemic barriers to health insurance for these groups. The bottom line is clear: Uninsurance was already increasing before 2020, and the COVID-19 economic crisis has left millions more without coverage. However, without the Affordable Care Act (ACA) the situation would be much more dire. This data illustrate how critical it is for policymakers to protect and strengthen the law.

Many of the millions of people who have lost jobs this year have also lost — or will soon lose — employer-based health insurance. Estimates suggest between 10 million to 30 million workers and their family members may lose their health insurance in 2020. Early evidence shows that Latino families are experiencing this hardship at particularly high rates. In one poll, 63 percent of Latino families reported losing employer coverage and over half (54 percent) also said their children were now uninsured.

This economic downturn is the first one in which the ACA is in place. It is providing affordable options for people who have lost employer coverage or work in jobs that pay low wages and don’t offer any benefits. The law created the biggest safety net for health insurance America has ever had, expanding Medicaid and giving people subsidies to buy insurance through the Marketplace.

Policymakers must ensure that people are able to access all available health insurance options. They can do so using the following strategies:

• Support Medicaid by investing additional federal funds in state programs. Thirty-nine states* (including DC) have expanded Medicaid under the ACA. This important program provides a path to health insurance for people who earn low incomes in jobs that don’t provide benefits. It’s also a lifeline for people who lose employer-based insurance when they lose their job. Medicaid eligibility is based on current income. Therefore, people would likely be eligible for the program if their monthly income is eliminated or it drops below the eligibility threshold, even if they had been earning a wage above the eligibility limit. Medicaid enrollment is expected to rise when the economy is struggling. And that’s exactly what is happening. In the 30 states for which data is available, about 6 million more people enrolled in Medicaid (an increase of 8.4 percent) between February and July. Notably, this increase only accounts for a portion of those who are newly uninsured, so we can expect enrollment to continue increasing. As people and their families continue to struggle with temporary furloughs becoming permanent or unemployment insurance decreasing, more people will need and be eligible for Medicaid. Federal policymakers must take additional steps to bolster Medicaid by providing more federal Medicaid dollars to states.
• Expand Medicaid. Unfortunately, many people don’t have Medicaid as an option because their states have, so far, refused to expand the program. This is the case for workers in 12 states who find themselves unemployed and without employer coverage, or those who are paid low wages and aren’t offered any benefits. This also includes many “essential” workers, such as child care providers. In these states, we can expect more people to become uninsured this year.
• Encourage Marketplace Enrollment. The ACA put private coverage within reach of more people by providing financial aid to help them afford it. Under the law, people with incomes between 100 and 400 percent of the poverty level ($21,720 to $86,880 for a family of three) can get tax subsidies to purchase health insurance through the Marketplace. Open enrollment this fall (November 1-December 15) will be a critical timeframe for those who are uninsured to explore their coverage options, learn what subsidies they quality for, and enroll in a Marketplace health plan. To enroll outside this open enrollment window, a person must qualify for a “special enrollment period.” Losing employer-based coverage is one way to meet that criteria. The Trump Administration has cut over 50 million dollars from health insurance Marketplace outreach and enrollment efforts. So, this year it’s especially important for policymakers and advocates to do all we can to educate and inform people about when and how they can get covered.

Read more about state strategies to increase access to affordable health insurance and ways for individuals to find coverage.

Despite the millions of people in need of insurance coverage during the pandemic, the Trump Administration supports a court case to eliminate the ACA in its entirety. The consequences of invalidating the ACA would be catastrophic—once again allowing insurers to deny coverage for pre-existing conditions; leaving young adults without an option to stay on their parents’ plans; ending Medicaid expansion that provides coverage for over 20 million people; and reinstituting lifetime limits on coverage.

It is especially dangerous to threaten these protections in a public health crisis. They are vital for people with low incomes and people of color, who have faced historic barriers to coverage. Rather than risking the health of working people and their families, policymakers should be expanding access to affordable care. 

*  Oklahoma, Missouri, and Nebraska have not yet implemented their Medicaid expansions.