How the COVID-19 Recession Could Affect Health Insurance Coverage

A man walking up the steps of a subway station.

Twenty-five million workers or more could lose employer-based health insurance due to COVID-19-related unemployment.



The Issue

An estimated 160 million people nationwide under the age of 65 had health insurance through their employer just before the COVID-19 pandemic hit. Thirty million workers filed for unemployment between March 15 and April 25, according to federal statistics. Rising unemployment is expected to significantly alter the health insurance coverage landscape, as millions who lose their jobs and their dependents enroll in Medicaid, purchase Marketplace coverage, or become uninsured.

Key Findings

In this brief, researchers estimate how 20 percent unemployment—expected in the coming months—could affect health insurance coverage. Findings include:

  • An estimated 25-43 million people could lose their employer-sponsored health insurance coverage.

  • More than half of the newly jobless will obtain Medicaid coverage in states that expanded Medicaid under the Affordable Care Act (ACA), while only about one-third will receive Medicaid coverage in the 15 states that have not expanded the program.

  • Less than a quarter of these workers and their dependents in expansion states will become uninsured, while about 40 percent in non-expansion states will become uninsured.


Researchers suggest several policy options to mitigate burdens on state budgets and the rise in uninsurance, such as temporarily enabling more Medicaid support in non-expansion states, expanding the income range for premium subsidies in the ACA marketplaces, providing subsidies for COBRA insurance, and enhancing Medicaid matching rates.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.