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How Obamacare helped millions who lost their jobs during Covid-19, in 3 charts

The Affordable Care Act faced its first big test as a safety net during Covid-19. New research finds it’s working well.

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

The Covid-19 pandemic has been the first serious test for the Affordable Care Act as a new social safety net — and the law’s provisions have proven adept, if imperfect, in protecting Americans from losing health insurance in the middle of an infectious disease outbreak and an economic crisis.

Two new analyses published in the last week explain concisely (as will I, aided by their charts) the depth of coverage losses resulting from the job losses of the last six months and the ACA’s success in catching many of those people to give them a new health insurance plan.

This piece by Harvard researchers Sumit Agarwal and Benjamin Sommers, published in the New England Journal of Medicine, lays out how the ACA has made it easier for people who lose their job and their employer-sponsored health insurance to find coverage. The law created private insurance markets, with federal subsidies to help people afford a plan, and encouraged states to expand Medicaid for people in or near poverty. Those provisions, especially Medicaid expansion, led to a meaningful reduction in the number of people who end up becoming uninsured after losing their job.


The Harvard researchers summarized their key finding like this:

In the post-ACA period ... job loss was no longer linked to an increase in the uninsured rate. Large gains in Medicaid (8.9 percentage points) and marketplace coverage (2.6 percentage points) nearly fully offset the reduction in ESI for people who left or lost their jobs. Overall, there was a 6.0 percentage point net reduction in loss of coverage after a job loss in the post-ACA period as compared with the pre-ACA period.

This data notably does not cover the coronavirus crisis itself, but it demonstrates Obamacare’s general capacity to function as a safeguard against coverage losses resulting from unemployment.

As Agarwal and Sommers wrote: “These results indicate the critical role that the ACA will play in alleviating coverage losses related to the Covid-associated recession.”

Still, no coverage losses during the Obama administration, when unemployment was on a consistent downward trajectory, can compare to what the US is enduring in the Covid-19 pandemic, when the jobless rate reached nearly 15 percent over the summer, though it has since recovered some.

New estimates from the Economic Policy Institute put the number of people who have lost the health insurance they or a family member previously got through their employer at about 12 million. There has been a significant churn in coverage since the spring.


Most — but not all — of the people who have lost coverage from their work have gotten coverage from another source, EPI authors Josh Bivens and Ben Zipperer wrote:

A new government survey measuring the economic consequences of the COVID-19 shock in real time indicates that for every 100 workers who were covered by ESI before losing their job, about 85 retained access to some form of health insurance in the week after they lost their job.

Medicaid in particular has picked up much of the slack, with its rolls swelling by 4 million during the downturn. The EPI analysis references previous research that shows that the percentage of unemployed workers covered by Medicaid in the states that have accepted the ACA’s Medicaid expansion is much higher than in nonexpansion states, 36 percent versus 16 percent.


“These data indicate strongly that it is Medicaid, not the ACA marketplace exchanges, that does the heavy lifting of providing a health insurance safety net for those workers who lose ESI,” Bivens and Zipperer wrote.

Medicaid expansion has often been underappreciated for its role in Obamacare’s success, accounting for more than half of the coverage gains since the law took effect. In the time of Covid-19, it has continued to prove its worth.

But as I covered last week ahead of Joe Biden’s DNC speech, until the dozen Republican-led holdout states come around on Medicaid expansion, or until Democrats pass a plan to extend coverage to the people left in the Medicaid expansion gap, the work of Obamacare will remain unfinished.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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