Changes in Health Insurance Coverage Due to the COVID-19 Recession: Preliminary Estimates Using Microsimulation

Patients complete paperwork in a waiting room.

More than 10 million people are estimated to lose employer-sponsored health insurance as a result of pandemic-related job loss in their household between April and December 2020.


The Issue

An estimated 48 million nonelderly people in the United States will be part of a household in which someone loses a job due to COVID-19, based on an assessment of pandemic-related job loss.

Key Findings

Using projections data on employment losses by industry, state, and demographic characteristics regularly published by the U.S. Department of Labor, researchers estimate the following about those 48 million nonelderly people:

  • Many of the workers and family members experiencing job loss within the family either had insurance through another family member’s job (34%) or through Medicaid or the Children’s Health Insurance Program (CHIP) (27%) prior to the pandemic.

  • About one-fifth of these people (10.1 million) had insurance tied to the job lost due to COVID-19. Smaller shares had coverage through the nongroup insurance market, other public programs, or were uninsured.

  • Projections show 3.3 million of those people will regain employer-sponsored insurance by being added to a family member’s policy, 2.8 million people will enroll in Medicaid, and 600,000 people will enroll in the individual market, mainly via the Affordable Care Act’s marketplace. Still, 3.5 million people will become uninsured.


The findings imply the COVID-19 recession is disproportionately affecting workers paid low wages, many of whom did not have employer-sponsored coverage even when they were working. Higher percentages of people losing their employer insurance will become uninsured in states that did not expand eligibility. 

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.