COVID-19 Pandemic's Impact on Health Insurance Coverage Highlighted in New Research

Research examining the effects of the COVID-19 pandemic on health insurance coverage for working-age adults in the United States reveals significant findings on income, income transitions, and the Affordable Care Act (ACA) Medicaid expansion. The study, conducted by a team of researchers from the University of California Los Angeles (UCLA), found that the Medicaid expansion played a crucial role in preventing declines in insurance coverage for disadvantaged individuals in expansion states. The research, published in Health Services Research, highlights the importance of income transitions and employment status in determining health insurance coverage during the pandemic.

Key Takeaways:

• The Medicaid expansion was found to be particularly beneficial for individuals with low pre-pandemic incomes who experienced unemployment spells during the pandemic, with a 7.5% point increase in Medicaid coverage.
• The expansion also provided significant benefits for individuals who transitioned from high pre-pandemic incomes to low pandemic incomes, regardless of whether they lost their jobs or remained employed.
• In non-expansion states, private exchange coverage was found to have a weaker effect in blunting increases in uninsurance.
• The study concludes that not only employment status and pre-pandemic income, but also income transitions, played a critical role in determining who received Medicaid coverage during the pandemic in Medicaid expansion states.

Statistics:

• 6435 adults aged 26-64 participated in the study.
• The study found that participants in all income groups who suffered spells of unemployment during the pandemic lost employer-sponsored insurance.
• In expansion states, the Medicaid expansion prevented declines in insurance coverage for disadvantaged participants.
• The expansion was particularly beneficial for participants with low pre-pandemic incomes who had unemployment spells during the pandemic (7.5% point increase in Medicaid coverage).
• The expansion also provided significant benefits for participants who transitioned from high pre-pandemic incomes to low pandemic incomes, without employment spells (23.9% point increase in Medicaid coverage).

Sources:

• Employment, Income, the Aca, and Health Insurance Coverage of Working-age Adults During the First Year of the Covid-19 Pandemic: a Reassessment. Health Services Research, 2025.
• University of California Los Angeles (UCLA), UCLA David Geffen School of Medicine, Dept. of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, CA 90095, United States.
• The study was funded by the Agency for Healthcare Research & Quality.