Making Sense of Competing Estimates: The COVID-19 Recession's Effect on Health Insurance Coverage

Caretaker holding patient's hand from hospital bed.

An in-depth comparative analysis of four studies indicates changes to people’s insurance coverage may not be as dramatic as initially thought.


The Issue

With millions of workers suddenly out of work, early projections of the effect that the pandemic would have on health coverage in the United States varied widely in both methodological approach and final projections.

Conducting a comparative analysis of four previously published studies, researchers suggest that despite millions of Americans losing their job due to COVID-19, changes to people’s health insurance coverage might not be as widespread as anticipated. However, researchers note that the projections and studies examined in their analysis are far from definitive and a full understanding of shifts in the overall number of people who are insured won’t be known until more definitive data points become available next year.

Key Findings

In analyzing the four studies, the authors note key methodological difference among the competing projections.

  • While every study estimates how many individuals would lose employment-based coverage, one study does not quantify the number of individuals who would become uninsured as a result of job loss.

  • Other studies attempt to incorporate projections of how many affected individuals would gain new access to coverage through a spouse/family member or through subsidized Medicaid or marketplace coverage.

  • One study focuses exclusively on the number of affected workers but does not account for family members and/or dependents who may be enrolled in an affected individual’s health plan.

  • Of these four estimates, only one uses a microsimulation model, which is a specific type of analytic tool built from large representative samples of individual and household data.


It remains unknown exactly how many people will lose both their jobs and health insurance coverage during the COVID-19 recession, and definitive data will not be available until next year. Though employment rebounded somewhat after the huge job losses in March and April 2020, the economic recovery is uncertain and depends on the course of the coronavirus and efforts to mitigate its spread. Recent household surveys with smaller sample sizes than federal surveys have, however, indicated that net changes in insurance coverage thus far have been small.

Without definitive data on how health insurance coverage is currently changing and will change in the coming months, models that predict the effects of widespread employment losses on coverage play an important role in alerting policymakers to potential outcomes.

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.