"COVID-19 continues to highlight longstanding structural inequities," Mona Shah, senior program officer at the Robert Wood Johnson Foundation, said in a statement.
Two new analyses connect the dots between losing work due to the COVID-19 pandemic and avoiding healthcare due to cost or concerns about contracting COVID-19. They show that almost half of families that lost work avoided healthcare.
The issue briefs, by researchers at the Urban Institute with funding from the Robert Wood Johnson Foundation, contain the first nationally representative estimates of changes in health insurance coverage during the pandemic-related recession.
They also examine healthcare avoidance related to the pandemic, which has been so pronounced that many top healthcare organizations are actively trying to convince patients to return to their doctors' offices for needed care.
The new analyses, however, show that it may take more than public service announcements and infection control assurances to get patients to return.
The health insurance issue brief shows that adults in families losing jobs reported a 4.9 percentage-point decline in employer-sponsored health insurance coverage. They also reported a 3.5 percentage-point increase in private nongroup coverage during this period.
The researchers also uncovered sobering differences between states with and without Medicaid expansion.
Among adults in states without expanded Medicaid, the overall share of adults who were uninsured increased by 1.4 percentage points. Among adults in families losing jobs in these states, the share with employer coverage fell by 6.2 percentage points, and the share with private nongroup coverage increased by 7 percentage points.
That's compared to families in states that did expand Medicaid. In those states, the share of families reporting employer coverage fell 4.2 percentage points, and the share reporting Medicaid/CHIP increased 2 percentage points. Uninsurance remained unchanged in these states, both overall and among those in families losing jobs.
"These findings suggest the Affordable Care Act may be preventing adults who lose work as a result of the pandemic from becoming uninsured, even as the law faces another challenge before the Supreme Court," Michael Karpman, senior research associate at the Urban Institute, said in a statement.
In their healthcare avoidance analysis, researchers found that 45.5% of adults in families losing work or work-related income reported unmet need for medical care in their family and/or avoided care because of concerns about exposure to coronavirus in the month before the survey, compared to 30.9% in families that did not lose work or income.
Care avoidance in families with lost work and income was more pronounced among lower income adults, those with uninsured family members, adults in families with chronic conditions, and parents living with children under 19.
"Our findings show adults in families who are losing work because of the pandemic's impact are more likely to face health care affordability challenges," Dulce Gonzalez, research analyst at the Urban Institute, said in a statement. "While affordability was already a serious concern before COVID-19, the pandemic has exacerbated these challenges."
Alexandra Wilson Pecci is an editor for HealthLeaders.