Study Finds Racial Coverage Disparities Following Unemployment

After becoming unemployed during the COVID-19 pandemic, Medicaid coverage gains helped offset private insurance losses for White individuals but not for Black and Hispanic individuals, highlighting racial coverage disparities.

Unemployment increased during the pandemic, rising from 3.5 percent in February 2020 to 14.7 percent in April before declining to 6.7 percent in December. Past research found that the growth in uninsurance among working-age adults was due to employer-sponsored insurance losses.

The study, published in JAMA Health Forum, used data from the National Health Interview Survey (NHIS) to assess racial and ethnic differences in uninsurance and coverage sources among adults who were continuously employed in 2019 and 2020 and those who were newly unemployed in 2020.

The weighted sample sizes included over 126 million continuously employed adults and over 16 million newly unemployed adults.

Newly unemployed adults were more likely to be women, less likely to be White, and had lower education levels and income compared to continuously employed people. Additionally, newly unemployed individuals were less likely to have private insurance in 2019 and more likely to have Medicaid.

Among all working-age adults, those employed in 2019 and those continuously employed, uninsurance and coverage sources did not change from 2019 to 2020.

Among newly unemployed adults, private insurance declined by 11.7 percentage points. This decrease was partially offset by a 5.2 percentage point increase in Medicaid coverage, but uninsurance still grew by 6.4 percentage points.

Notably, the decline in private insurance was offset by increased Medicaid coverage among newly unemployed White adults but not among newly unemployed Black or Hispanic adults. This led to higher uninsurance rates for Black and Hispanic individuals than their White counterparts.

Black (46 percent) and Hispanic (36 percent) adults were more likely than White adults (33 percent) to live in states that had not expanded Medicaid by 2020, which may have contributed to the racial disparities in uninsurance rates.

However, the findings are likely attributed to the fact that Black and Hispanic individuals who lost employer-sponsored insurance during the first year of the pandemic faced more structural and administrative barriers to Medicaid enrollment than White adults, researchers theorized.

The pandemic exposed significant racial care and coverage disparities.

A report from the State Health Access Data Assistance Center (SHADAC) found that American Indian and Alaska Native children had the highest uninsurance rate across all racial and ethnic groups at 14.1 percent. Latino children and Native Hawaiian and other Pacific Islander children followed with uninsurance rates of 7.8 percent and 6 percent, respectively.

Data from BlueCross BlueShield of Tennessee revealed racial care disparities in several areas. For example, Black Tennesseans were two and half times more likely to have a pregnancy-related death and two times as likely to die from diabetes than White women.

Previous research has reinforced the findings that Medicaid expansion may be tied to lower uninsurance, particularly among racial and ethnic minorities. In states that expanded Medicaid, 9.1 percent of adults were uninsured in 2021 compared to 18 percent in non-expansion states, according to data from the Commonwealth Fund.

Additionally, coverage disparities were lower in states that expanded Medicaid. The difference between Black and White adult uninsurance rates was 3.3 percentage points in expansion states compared to 5.7 points in non-expansion states.