COVID-19 and Job Losses Will Test the US Health Insurance Safety Net

Bottom Line:

The Affordable Care Act and Medicaid expansions are a safety net providing Americans with health insurance following the widespread loss of employment-based health insurance during the current economic crisis.


Levitt L. COVID-19 and Massive Job Losses Will Test the US Health Insurance Safety Net. JAMA Health Forum. American Medical Association (2020).

Date Published:

28 May 2020


With extensive job losses during the current COVID-19 induced economic crisis, the US is at risk of a historic decrease in employment-based health insurance. A recent analysis by the Kaiser Family Foundation found that 26.8 million Americans in households with employment loss are at risk of losing health insurance. Although this would almost double the number of uninsured individuals if it were to happen, fortunately there are now some reasons this is unlikely. Some currently unemployed workers may soon return to work as businesses start to re-open, and other employers are temporarily maintaining benefits for furloughed employers. Most importantly, for the first time during an economic crisis, Americans will have the Affordable Care Act (ACA) as a safety net for those who lose job-based health insurance. People with low or modest income qualify for premium subsidies in the ACA marketplace, and Medicaid has been expanded (with an exception of 14 states) to cover individuals who fall below or are just above the poverty level. The analysis mentioned above estimates that 79% of the 26.8 million losing employment-based healthcare will qualify for government help regarding healthcare fees (12.7 million under Medicaid and 8.4 million under the ACA premium subsidies). As expansions in Medicaid have not been observed in all states, protections for Americans will vary significantly depending on where they live. For example, in California which has expanded Medicaid, 60% of the 3.4 million people at risk of losing coverage will be eligible for Medicaid. Conversely, in Texas which has not expanded Medicaid, only 20% of the 1.6 million at risk of losing coverage are eligible for Medicaid. However, many of these individuals will be eligible for ACA premiums instead. Despite this, President Trump continues to support a lawsuit to overturn the ACA entirely, with arguments to be heard by the Supreme Court in the fall. Although the ACA is not without flaws, healthcare without the ACA would be dismal in the midst of concurrent public health and economic crises.

Summary by: Spandana Amarthaluru