Job losses and the uninsured rate in the pandemic: A one-state snapshot
Let's try a somewhat ambiguous one-state snapshot -- in New Jersey, my home state -- of the extent to which ACA programs may have blunted an increase in the uninsured population during the months when Covid-19 triggered huge increases in unemployment.
According to the New Jersey Department of Labor, job losses due to the pandemic peaked at about 835,500 and stood at 426,110 as of August. Estimates of the ratio between the number of people losing jobs and the number losing insurance vary quite a bit, and the ratio probably varies quite a bit by state, depending on the types of jobs lost. The pandemic created novel conditions, in which a fair number of workers were furloughed and were able to keep their job-based insurance, at least for a while.
In New Jersey, as in most states that enacted the ACA Medicaid expansion, Medicaid is the primary safety net for the newly uninsured. Enrollees rendered eligible by the expansion -- adults with incomes up to 138% of the Federal Poverty Level -- are driving rapid growth in Medicaid enrollment in the state. Here's the story since February:
Medicaid Enrollment Growth in New Jersey in the Pandemic
Coverage group
Feb 2020
Sept 2020
Increase Feb-Sept
% increase Feb-Sep
ACA expansion adults
510,850
597,002
86,152
16.9%
Non-ABD children
773,544
835,543
61,999
8.0%
All Medicaid
1,682,621
1,853,928
171,307
10.2%
Source: NJ FamilyCare Monthly Enrollment StatisticsSubscribe to xpostfactoid
What about the ACA marketplace? From the first quarter to the second, total individual market enrollment in the state is down 1.76%, to 311,022. That's not a bad performance: attrition in the marketplace is usually continuous throughout the year. (Nationally, if enrollment stays flat from February through December, enrollment in December 2020 would be up by about 1.5 million over December 2019.) From 2016 through 2018, attrition from the first to second quarter in New Jersey averaged 6%.
Somewhat complicating the picture is even more minimal second quarter attrition in 2019 than in 2020: last year, the second quarter drop in New Jersey was just 0.74%. That may be due in part to a premium drop in 2019 effected by the enactment of a reinsurance program: off-exchange enrollment, which is unsubsidized, rose 1.22% in the second quarter of 2019 (quarterly reports are available here).
In any case, the individual market can hardly be considered a major factor in picking up those who lost job-based coverage -- at least outside of the Open Enrollment Period, which begins on November 1. With the launch of supplemental state-based subsidies in 2021, as well as a new state-based marketplace with its own funding source for advertising and enrollment assistance, New Jersey is pinning some hopes on an enrollment boost in the coming OE period.
One more equivocal bit of data. The Census Bureau's experimental Pulse Survey, conducted online, is posting weekly or biweekly uninsurance estimates by state. The results are quite volatile. In New Jersey, the average uninsured rate for the population aged 18-64 in the last three periods, running from August 19 to September 28, is 10.8%. The Kaiser Family Foundation's estimate for New Jersey adults aged 19-64 in 2018, based on the Census' American Community Survey, is 11%.
I doubt that the uninsured rate in New Jersey has stayed flat in the pandemic. But Medicaid is pretty clearly doing yeoman's work to reduce the spike.
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