Bolstered by Recovery Legislation, the Health Insurance Safety Net Prevented a Rise in Uninsurance Between 2019 and 2021

Nursing Prize 2018 - Stefan Torres

Improved health insurance safety net prevents catastrophic coverage losses feared at the onset of COVID-19.



The Issue

The health insurance safety net, enhanced by COVID-19 pandemic legislation, prevented major coverage losses and reduced uninsurance. With the end of Medicaid’s continuous coverage requirement nearing, uninsurance rates could begin to once again rise.

Key Findings

  • The health insurance safety net successfully prevented a long-term rise in uninsurance about a year after the pandemic began

  • Medicaid’s continuous coverage requirement has been a key driver of enrollment trends. 

        o   Enrollment trends suggest the Marketplace played an important role in preventing uninsurance. 

  • Gains in Medicaid coverage largely offset significant losses of employer coverage.

  • Adults with incomes below the federal poverty level in states that have not expanded Medicaid will continue to have few options for affordable coverage. 


Researchers note pending legislation could continue to strengthen the health insurance safety net and fill the Medicaid coverage gap. State policymakers encourage setting an expiration date for continuous coverage requirements to help states plan their redetermination process. Experts suggest that timely public reporting of disenrollments and coordination between state Medicaid agencies and Marketplaces are essential to monitoring the requirement’s rollback and ensuring states avoid disenrolling eligible Medicaid enrollees. 

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.