The year 2020 is certainly going to be one to remember in the history books. The current recession associated with the pandemic is undoubtedly going to result in more people enrolling in public coverage and, sadly, will also drive up the uninsured rate in the U.S (especially in states that have not expanded Medicaid). But how many and when? Recent data and anecdotal experience, however, suggest that this question is increasingly hard to answer as this recession may be acting differently than past downturns.

As readers of SayAhh! know, we have been closely monitoring what is happening with respect to Medicaid enrollment. So far, we are seeing a good degree of variability among states that we are tracking.  A new report released this week by researchers at the Urban Institute provides new projected estimates of how many people will become uninsured or be newly enrolled in Medicaid/CHIP that are significantly lower than earlier projections from May.  

Some of the key findings of the report include:

• By the end of 2020 there will be a 6.1 percent increase in Medicaid/CHIP enrollment nationwide with an additional 4.3 million non-elderly adults and children enrolling. This is substantially lower than previous estimate of between 8 to 12 million.
• States that have expanded Medicaid are likely to see larger increases in enrollment (7.3 percent) as opposed to states that have not (3.1 percent).
• The number of uninsured people will rise by 10 percent in 2020 – an increase of 2.9 million adults and children over the course of 2020

One of the reasons this recession may differ dramatically from prior recessions, as report authors point out, is that certain sectors of the economy were affected very quickly and harshly while others were largely unchanged. This recession hit hard and fast at industries with a larger proportion of low wage workers (like restaurants, retail and tourism)  – many of whom likely didn’t have employer-sponsored insurance to begin with. Another recent report from the Commonwealth Fund finds that 59 percent of those who lost their jobs early on or were furloughed did not have employer sponsored insurance.

As a consequence some of those losing their jobs early on may have been uninsured already and unfortunately will stay that way – especially if they live in states that have not expanded Medicaid. And a greater number of them may have had Medicaid to begin with as compared to past recessions because of the ACA Medicaid expansion. However, the authors point out that as the recession continues and layoffs spread to other sectors such as state and local governments, the loss of employer-sponsored insurance is likely to grow. 

Another set of transitions, of course, is between public sources of coverage. Children whose families are losing income may move from CHIP to Medicaid – many states have been seeing this already.  And adults who are enrolled in tax-subsidized Marketplace plans may become eligible for Medicaid as they lose income – if their state has expanded.

In past recessions, Medicaid enrollment has lagged increases in the unemployment rate. This may occur again this time, though perhaps for somewhat different reasons.  Anecdotal evidence suggests that many families have been more focused on obtaining unemployment insurance benefits – which has been far too difficult in many places.

And many are not rushing to the doctor or hospital these days unless they view it as absolutely necessary because of safety concerns. Health care providers often provide outreach and facilitate applications for Medicaid. This too may delay newly eligible people from enrolling in Medicaid and CHIP. Finally there has been no effort by the Trump Administration to inform families, especially those who are newly unemployed, of their possible eligibility for public coverage.