Boosting Tax Credits and Other Aid Could Prevent Health Insurance Loss During Future Recessions
Nov 15, 2021
The coronavirus disease 2019 pandemic–related recession and resulting job loss raised significant concerns that the U.S. uninsured population could increase, perhaps by millions. However, worrisome predictions about coverage loss have not materialized. RAND researchers (1) assess the importance of temporary provisions in stabilizing health insurance enrollment despite heavy job loss and (2) run simulations using New York state as a case study.
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The coronavirus disease 2019 (COVID-19) pandemic–related recession and resulting job loss raised significant concerns that the U.S. uninsured population could increase, perhaps by millions. However, predictions about coverage loss have not materialized. Because this recession is the first economic downturn since the Affordable Care Act's (ACA's) major coverage provisions took effect in 2014, a possible explanation for the lack of coverage loss is that the ACA's safety-net provisions — such as Medicaid expansion and Advance Premium Tax Credits (APTCs) for marketplace coverage — did their job.
However, it is also possible that other responses to the pandemic contributed to the maintenance of insurance levels. For example, more than half of covered workers who lost their jobs as a result of the pandemic retained their employer-sponsored insurance, perhaps because the layoffs were not expected to be permanent. Temporary policies to retain Medicaid enrollees appear to have increased insurance enrollment. Furthermore, some states opened their health care marketplaces for a special enrollment period in 2020, enabling people to newly enroll in insurance in the middle of the year. In 2021, the American Rescue Plan, which temporarily enhanced marketplace tax credits, also led to an enrollment bump.
To explore this issue, RAND researchers (1) assess the importance of temporary provisions relative to long-standing policies in stabilizing health insurance enrollment despite heavy job loss and (2) run simulations using New York state as a case study.
Additional Detail on Methods and Data
This research was funded by the New York State Health Foundation and carried out within the Payment, Cost, and Coverage Program in RAND Health Care.
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