The share of adults reporting public coverage increased from 13.6 to 17.5%, an increase of approximately eight million adults.

Although the number of uninsured adult Americans has held steady at about 11% during the pandemic, the source of coverage has changed for some people.

Pandemic-related job losses resulted in a decrease in the number of people receiving health insurance through their employers and increased enrollment in public programs, according to a recent study by the Urban Institute that was funded by the Robert Wood Johnson Foundation. "Unlike the last recession, losses in employer-sponsored insurance during the pandemic did not lead to growth in the number of uninsured," said Michael Karpman, senior research associate at the Urban Institute. "Medicaid and the health insurance Marketplaces provided many people with a safety net that allowed them to maintain coverage during difficult times."

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Related: Infographic: Who are America's uninsured?

Researchers analyzed changes in health insurance coverage among nonelderly adults between March 2019 and April 2021. Among the key findings:

  • The percentage of U.S. adults reporting they had employer-sponsored coverage declined from 65 to 62.3%, a decrease of approximately 5.5 million adults.
  • The share of adults reporting public coverage increased from 13.6 to 17.5%, an increase of approximately eight million adults.
  • Public coverage gains occurred in states that both did and did not expand access to Medicaid under the ACA. The percentage of adults reporting public coverage in states that expanded Medicaid increased from 14.9% to 19.2%. The percent of adults reporting public coverage in non-expansion states increased from 10.7% to 14.3%.
  • In April, the uninsurance rate in non-expansion states was more than double that of expansion states (18.2% vs. 7.7%). More than one in three low-income adults in non-expansion states were uninsured in 2021, compared with about one in seven low-income adults in expansion states.

"Those who suffered the most from the economic fallout associated with COVID were low-wage workers, so the loss of job-related coverage was less than in previous recessions," said Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation. "The enhanced safety net provided by the ACA was critical in keeping people covered, especially in states that expanded Medicaid."

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Alan Goforth

Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.