The Uninsurance Rate Held Steady During the Pandemic as Public Coverage Increased

In an examination room, a nurse makes notes and a patient and her baby wait.

Amid the pandemic and related economic recession, enrollment gains in public insurance plans helped offset declines in employer-sponsored insurance. Unlike previous recessions, the uninsurance rate did not change.



The Issue

Rapid job losses in the early months of the COVID-19 pandemic raised fears that millions of people would lose their health insurance coverage and become uninsured. As the pandemic posed the first test of the post-Affordable Care Act health insurance safety net during an economic downturn, Congress further supported access to coverage by not allowing disenrollment from Medicaid through the March 2020 Families First Coronavirus Response Act. The authors examine changes in health insurance coverage among nonelderly adults during the pandemic, using data from the Institute's Health Reform Monitoring Survey. 

Key Findings

  • Between March 2019 and April 2021, the share of nonelderly adults reporting employer-sponsored insurance declined from 65.0 percent to 62.3 percent, a decrease of approximately 5.5 million adults. Over the same period, the share reporting public coverage increased from 13.6 percent to 17.5 percent, an increase of approximately 7.9 million adults. The national uninsurance rate held steady at approximately 11 percent.

  • The share of adults reporting public coverage increased in all 50 states, however coverage gains were larger in states that expanded access to Medicaid. Such coverage increased from 14.9 percent to 19.2 percent in expansion states and from 10.7 percent to 14.3 percent in nonexpansion states.

  • More than 1 in 3 adults with low incomes in nonexpansion states (37.7%) were uninsured in 2021, compared with about 1 in 7 of such adults in expansion states (14.5%).


Despite the economic ravages of the COVID-19 pandemic, Marketplace and public coverage plans offset losses of employer-sponsored insurance coverage. Researchers say maintaining the current uninsurance rate will require protecting coverage for current and prospective Medicaid enrollees as the economy improves and the disenrollment freeze is lifted.

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.