February 11, 2021
HP-2021-02

TRENDS IN THE U.S. UNINSURED POPULATION,
2010-2020
The number of uninsured nonelderly Americans fell from 48 million in 2010 to 28
million in 2016, before rising to 30 million in the first half of 2020.
Kenneth Finegold, Ann Conmy, Rose C. Chu, Arielle Bosworth, and Benjamin D. Sommers

KEY POINTS• 30 million U.S. residents lacked health insurance in the first half of 2020, according to newly released
estimates from the National Health Interview Survey (NHIS).
• This number reflects a sharp decline in the number of uninsured Americans since 2010, before
implementation of the large coverage expansions under the Affordable Care Act (ACA). The ACA
produced particularly large coverage gains for Blacks, Latinos, Asian Americans, and Native Americans,as well for lower-income families.
• However, the uninsured rate has increased since 2016, even prior to the COVID-19 pandemic. From2017-2019, the uninsured rate rose by 1.7 percentage points, most likely due to new policy changes tocoverage options available under the ACA and Medicaid.
• Estimates from the NHIS show no significant change in uninsured rates during the early months of the
COVID-19 pandemic. However, the pandemic itself created challenges in conducting the survey that
may affect estimates of the uninsured, due to reduced response rates and a temporary shift from an inperson survey to a telephone survey.
• Compared with other Americans, the uninsured are disproportionately likely to be Black or Latino; beyoung adults; have low incomes; or live in states that have not expanded Medicaid.

BACKGROUND
Health insurance is a critical determinant of access to health care. Efforts to expand coverage are central to
improving health equity and responding to the health and economic challenges of the COVID-19 pandemic.
Newly released estimates from the Centers for Disease Control and Prevention (CDC) National HealthInterview Survey (NHIS) provide federal survey data on health coverage for the early period of the COVID-19
pandemic and show that 30 million U.S. residents lacked health insurance in the first half of 2020. 1
In this Issue Brief, we review the new NHIS findings in the context of health coverage trends from 2010
through 2020 and the policy changes occurring during this period. We also examine disparities in coverage
rates by race/ethnicity, income, age, and state Medicaid expansion status. We conclude with an overview ofcurrent efforts to expand health coverage including a new Executive Order on coverage and a Special
Enrollment Period for the ACA Marketplaces beginning February 15, 2021.
February 2021

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1

ESTIMATES OF THE UNINSURED OVER TIMENHIS provides reliable federal survey data that tracks changes in health coverage, including the number ofuninsured, since 1972. 2 These data suggest the considerable impact of the ACA on coverage since its
enactment in 2010. The number of nonelderly (under 65) uninsured fell from 48.2 million in 2010 to 44.3
million in 2013 as the dependent coverage provisions of the ACA took effect (allowing young adults to stay on
a parent’s plan until age 26), and the economy improved after the Great Recession (Figure 1).
In 2014, the uninsured population began to decrease substantially, when Medicaid expansion was
implemented in selected states and Marketplace coverage became available with Premium Tax Credits andCost-Sharing Reductions for those who qualified based on income. The number of nonelderly uninsured fell to
35.7 million in 2014, with additional declines in 2015 and 2016 as more states expanded Medicaid andMarketplace enrollment grew. By 2016, the number of uninsured individuals had fallen by 20.0 million people(more than 40 percent) since 2010, with 28.2 million nonelderly uninsured at that time.
However, from 2017 to 2019, the number of uninsured rose each year, despite the strong economic conditions
during this period. By 2019, the last pre-pandemic NHIS estimate was that there were 32.8 million nonelderly
people without health insurance, an increase of 4.6 million (or 14 percent) from 2016.
Data for the first two quarters of 2020, shown in Figure 1, suggest that on average 30.0 million nonelderly
were uninsured over the course of those six months. 3 As noted above, earlier predictions that the loss of
employment in the March/April period would trigger a commensurate rise in the uninsured were not evident
in the newest NHIS estimates. However, the pandemic itself introduced several methodological challenges to
conducting the survey, including a shift from an in-person survey to a telephone survey and a lower response
rate, particularly among younger and lower-income respondents. 4 These changes may have affected the newcoverage estimates, as discussed at more length later in this report.

February 2021

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Figure 1. U.S. Nonelderly Uninsured Population, 2010-2020 (in millions)
50.0

48.2

45.9

Estimated Uninsured (in millions)

45.0

45.2

44.3

40.0

35.7

35.0
30.0

28.4

28.2

28.9

2015
Year

2016

2017

30.1

32.8

30.0

25.0
20.0
15.0
10.0
5.0
0.0

2010

2011

2012

2013

2014

2018

2019

2020

Source: Early release of estimates from the National Health Interview Survey, 2010-2020. National Center for Health Statistics. Available
from https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm. 2020 estimates are for January-June only.

Figure 2 presents annual percentages of the uninsured from 2010-2020. With the implementation of several
major provisions of the Affordable Care Act in 2014, the uninsured rate of nonelderly individuals dropped
precipitously and continued to decrease until 2017. From 2016 to 2019, the rate of uninsured persons
increased by a total of 1.7 percentage points, from 10.4 percent in 2016 to 12.1 percent in 2019. Over theentire observation period, the uninsured rate decreased by 6.8 percentage points, from 18.2 percent in 2010
to 10.8 percent in the second quarter of 2020. Figure 3 shows the annual declines in the uninsured rate from2010 to 2016, the increases from 2016 to 2019, and the change from 2019 to the first half of 2020. The lastcolumn sums those year-by-year changes to show the cumulative change from 2010 to 2020.

February 2021

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Figure 2. Uninsured Share of U.S. Nonelderly, 2010-2020
20%

18.2%

17.3%

16.9% 16.6%

Estimated Share Uninsured

15%

13.3%

10.5%

10.4% 10.7%

2015
Year

2016

11.1%

12.1%

11.1%

10%

5%

0%

2010

2011

2012

2013

2014

2017

2018

2019

2020

Source: Early release of estimates from the National Health Interview Survey, 2018-2020. National Center for Health Statistics. Available
from https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm. 2020 estimates are for January-June only.

February 2021

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Figure 3. Changes in percent of persons under age 65 who were uninsured at the time of interview, 2010–2020

Source: Early release of estimates from the National Health Interview Survey, 2018-2020. National Center for Health Statistics. Available
from https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm. 2020 estimates are for January-June only.

RACIAL, ETHNIC, AND INCOME-BASED DISPARITIES IN THE UNINSURED RATE
Throughout the past decade, there have been large racial and ethnic disparities in rates of insurance coverage(Figure 4). While these coverage gaps have narrowed since implementation of the ACA, most minority groups
remained at persistently higher rates of uninsurance in 2019 than Whites. Individuals who identified as
American Indian or Alaskan Native were most likely to be uninsured; in part, this reflects that individuals who
only have coverage through the Indian Health Service are classified by NHIS and other federal surveys as being
uninsured. Individuals who identified as Hispanic or Latino had the second highest rate of uninsured
individuals, with 32 percent in 2010. From 2010 to 2019, the rate of uninsured Hispanic individuals decreasedby nearly one third, but at 22 percent in 2019 it is still almost 2.5 times the rate for White individuals (whose
uninsured percentage dropped from 14 to 9). Asian Americans’ uninsured rate decreased from 17 percent to 7
percent. Native Hawaiians and Other Pacific Islanders also experienced a large decrease in the uninsured rate.

February 2021

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Figure 4. Percent of individuals under age 65 who were uninsured at time of interview, by race, 2010 – 2019

Sources: National Center for Health Statistics, National Health Interview Survey, 2010-2019 5
Notes: In this analysis, individuals were defined as uninsured if they did not have any private health insurance, Medicare, Medicaid,Children’s Health Insurance Program (CHIP), state-sponsored or other government plan, or military plan. Individuals were also definedas uninsured if they had only Indian Health Service coverage or had only a private plan that paid for one type of service, such asaccidents or dental care. Data are based on household interviews of a sample of the civilian non-institutionalized population. Native
Hawaiian or Other Pacific Islander and American Indian or Alaska Native populations did not have estimates available for 2019 due tosample size considerations.

Figure 5 indicates that the decline in the uninsured rate in 2014 and 2015 disproportionately occurred among
lower and lower-middle income populations. In contrast, between 2016 and 2018, the uninsured population
grew modestly in most income groups. The relative gap in insurance coverage by income narrowed over the2010 to 2018 period but coverage rates continue to vary widely by household income.

February 2021

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Figure 5. Percent of persons under age 65 who were uninsured at the time of interview by family income,2010 – 2018

Sources: National Center for Health Statistics, National Health Interview Survey, 2010-2018 6
Notes: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. This table is based on
responses about all persons in the family. Data came from the Person file and were weighted using the Person weight. Unknowns forthe columns were not included in the denominators when calculating percentages.

STATE-BASED DIFFERENCES IN INSURANCE COVERAGE
While the country as a whole experienced a significant reduction in the rate of uninsured individuals in 2014
and 2015, the changes were largest in the states that have expanded Medicaid under the ACA. 7 The uninsured
rate among adults 18-64 in expansion states was cut in half from 18.4 percent in 2013 to 9.2 percent in 2016,
and was 9.1 percent in 2019. In non-expansion states, there were modest reductions in the uninsured ratefrom 2013 to 2016 (from 22.7 percent to 17.9 percent), but the uninsured rate has remained nearly twice ashigh as that in expansion states in 2019 (17.1 percent vs. 9.1 percent) (Figure 6).

February 2021

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Figure 6. Percentage of adults aged 18–64 who were uninsured at the time of interview, by year and state
Medicaid expansion status: United States, 2013–2019

Sources: 2010-2019: Cohen RA, Terlizzi EP, Martinez ME. Health insurance coverage: Early release of estimates from the National
Health Interview Survey, 2018. National Center for Health Statistics. May 2019. Available from:https://www.cdc.gov/nchs/nhis/releases.htm.
Notes: For 2013 and 2014, there were 26 Medicaid expansion states including District of Columbia. For 2015, there were 29 Medicaid
expansion states. For 2016–2018, there were 32 Medicaid expansion states.

The impact of states electing to expand Medicaid is also evident in Table 1, which shows coverage totals bystate based on data from the Census Bureau’s 2019 American Community Survey Public Use Microdata Sample(ACS PUMS), currently the most recent year of data available for state-by-state estimates. Texas and Florida,with the second and third largest populations of any state and no Medicaid expansion, account for 5.4 million
and 2.9 million of the nonelderly uninsured. The two other largest non-expansion states, Georgia and North
Carolina, each have more than one million uninsured individuals. As of 2019, more than one in three of thenation’s nonelderly uninsured population resided in these four states.

February 2021

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Table 1. Type of Health Coverage Among the Nonelderly Population, Number of People, by State (2019)
State
Alabama
Alaska*Arizona*
Arkansas*
California*
Colorado*
Connecticut*
Delaware*District of Columbia*
FloridaGeorgia
Hawaii*
Idaho
Illinois*
Indiana*
Iowa*
KansasKentucky*Louisiana*
Maine*
Maryland*
Massachusetts*
Michigan*Minnesota*
Mississippi
MissouriMontana*
Nebraska
Nevada*New Hampshire*
New Jersey*
New Mexico*
New York*
North Carolina
North Dakota*
Ohio*
Oklahoma
Oregon*Pennsylvania*
Rhode Island*South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont*
Virginia*
Washington*West Virginia*
Wisconsin
Wyoming
Total

February 2021

Medicare194,481
12,451
170,365
121,519
708,146
94,291
73,41524,45416,003556,080
279,746
23,97642,592
269,594
186,345
67,556
68,958187,066
158,609
53,040142,998
148,275
313,114
94,523
114,424
190,969
26,29235,25959,32733,821
183,434
63,819452,244
290,485
12,672
301,496
130,799
95,825360,370
33,583
155,448
20,863
195,567
575,264
40,98318,936
194,348
149,908
80,228125,344
12,626
7,961,931

Military
188,291
90,551
211,839
80,464775,004
252,150
53,58736,747
19,445
674,497423,510138,018
51,933
184,333
125,886
59,621
112,647
120,832
125,306
38,972
226,763
67,879128,934
79,20894,535
165,21238,96758,858102,882
27,192
92,11377,584
196,180
481,858
35,728
195,363
159,900
87,388
198,827
19,950230,018
29,573
224,531
860,495
67,20912,761
704,649
318,210
46,34996,061
19,123
8,907,933

Medicaid
732,350
124,742
1,269,166
652,397
8,455,982
809,532
633,833
162,838
140,9672,770,980
1,433,637
197,569
226,957
2,003,514
1,004,163
515,991
327,492
943,956
1,147,881
191,379
950,586
1,213,697
1,781,040
835,183
552,600
710,237
189,262
190,771
460,604
151,617
1,228,466
575,250
4,093,603
1,507,633
74,1042,006,996
551,188
737,077
2,104,571
167,890771,277
91,143
1,086,653
3,767,819
245,430
119,203
948,558
1,282,374
386,923751,635
53,34953,332,065

Type of Coverage
Employer
Nongroup
2,172,176
271,491
303,118
25,065
3,107,576
373,416
1,193,370
160,606
18,056,451
2,602,647
2,901,095
394,271
1,793,412
174,762
450,343
41,616362,656
53,9578,140,138
1,977,990
4,905,289
581,876
672,624
56,734
834,320
157,256
6,593,396
651,758
3,429,889
304,588
1,650,908
155,522
1,490,005
163,349
1,987,177
175,466
1,817,069
222,450
588,312
77,681
3,083,026
323,828
3,688,838
393,6444,882,244
527,149
3,146,106
289,735
1,180,083
142,491
3,022,263
354,516
432,076
84,616
1,047,729
130,353
1,437,122
164,981731,20376,555
4,718,618
482,308710,237
82,586
9,249,030
1,146,726
4,571,836
697,123
398,003
66,5295,883,001
465,425
1,669,199
216,232
1,989,203
237,389
6,313,695
668,272
535,625
71,3092,185,983
306,718
430,172
72,8793,085,238
384,698
13,044,068
1,607,854
1,880,024
295,986
288,042
33,1284,204,695
439,622
3,786,689
374,748
739,895
47,4403,181,181
306,026
282,01140,750154,246,459 19,154,117

Uninsured
490,226
82,446
840,445
287,1703,078,622
460,110
205,946
68,67325,0272,860,759
1,469,494
58,073
185,556
924,271598,268
151,806
272,630
297,357
436,211
108,374
356,975
208,673
589,382
274,202404,288634,023
88,745
157,526
357,790
87,559700,005
209,125
1,019,979
1,188,786
54,817
793,092
599,504
303,249
765,682
43,576562,070
85,410716,0115,400,579
311,514
26,786
684,085494,757
125,043344,232
71,30630,560,235

Total
4,049,015
638,373
5,972,807
2,495,526
33,676,852
4,911,449
2,934,955
784,671
618,055
16,980,444
9,093,552
1,146,994
1,498,614
10,626,866
5,649,139
2,601,404
2,435,081
3,711,854
3,907,526
1,057,758
5,084,176
5,721,006
8,221,863
4,718,957
2,488,421
5,077,220
859,958
1,620,496
2,582,706
1,107,947
7,404,944
1,718,601
16,157,762
8,737,721
641,853
9,645,373
3,326,822
3,450,131
10,411,417
871,933
4,211,514
730,040
5,692,698
25,256,079
2,841,146
498,856
7,175,957
6,406,686
1,425,878
4,804,479
479,165
274,162,740

ISSUE BRIEF

9

Notes: * Medicaid expansion state in 2019. Among states shown as non-expansion in 2019, Idaho, Nebraska, and Utah expanded in
2020; Missouri and Oklahoma votes approved Medicaid expansion and implementation is planned in both states for July 2021.
Individuals reporting more than one type of coverage are assigned using hierarchy of Medicare, Military (Tricare and VA),
Medicaid/CHIP, Employer-Sponsored Insurance, and Nongroup (Marketplace and off-Marketplace). Individuals reporting no coverageor coverage from Indian Health Service only are assigned as Uninsured.
Source: ASPE analysis of 2019 American Community Survey Public Use Microdata Sample (ACS PUMS).

Table 2 shows each state’s distribution of health insurance coverage by type of coverage. Texas, at 21.4
percent, has the highest percentage of nonelderly who are uninsured, and the next five states with the highest
share of uninsured (Oklahoma, Florida, Mississippi, Georgia, and Wyoming) are also non-expansion states. The
share of the under-65 population with Medicare is small, about 3 percent, because it is only available to thosewith disabilities or End-Stage Renal Disease. Military coverage for families of active service members andveterans is high in Alaska, Hawaii, and Virginia due to the locations of defense facilities. The highest Medicaid
share is in New Mexico, which expanded Medicaid.
Table 2. Type of Health Coverage Among the Nonelderly Population, By State (2019)
State
Alabama
Alaska*Arizona*
Arkansas*
California*
Colorado*
Connecticut*
Delaware*District of Columbia*
FloridaGeorgia
Hawaii*
Idaho
Illinois*
Indiana*
Iowa*
KansasKentucky*Louisiana*
Maine*
Maryland*
Massachusetts*
Michigan*Minnesota*
Mississippi
MissouriMontana*
Nebraska
Nevada*New Hampshire*
New Jersey*
New Mexico*
New York*
North Carolina
North Dakota*
Ohio*
Oklahoma
Oregon*February 2021

Medicare
4.8%
2.0%
2.9%
4.9%
2.1%
1.9%
2.5%
3.1%
2.6%
3.3%
3.1%
2.1%
2.8%
2.5%
3.3%
2.6%
2.8%
5.0%
4.1%
5.0%
2.8%
2.6%
3.8%
2.0%
4.6%
3.8%
3.1%
2.2%
2.3%
3.1%
2.5%
3.7%
2.8%
3.3%
2.0%
3.1%
3.9%
2.8%

Military
4.7%
14.2%
3.5%
3.2%
2.3%
5.1%
1.8%
4.7%
3.1%
4.0%
4.7%
12.0%
3.5%
1.7%
2.2%
2.3%
4.6%
3.3%
3.2%
3.7%
4.5%
1.2%
1.6%
1.7%
3.8%
3.3%
4.5%
3.6%
4.0%
2.5%
1.2%
4.5%
1.2%
5.5%
5.6%
2.0%
4.8%
2.5%

Type of Coverage
Medicaid Employer Nongroup
18.1%
53.6%
6.7%
19.5%
47.5%
3.9%
21.2%
52.0%
6.3%
26.1%
47.8%
6.4%
25.1%
53.6%
7.7%
16.5%
59.1%
8.0%
21.6%
61.1%
6.0%
20.8%
57.4%
5.3%
22.8%
58.7%
8.7%
16.3%
47.9%
11.6%
15.8%
53.9%
6.4%
17.2%
58.6%
4.9%
15.1%
55.7%
10.5%
18.9%
62.0%
6.1%
17.8%
60.7%
5.4%
19.8%
63.5%
6.0%
13.4%
61.2%
6.7%
25.4%
53.5%
4.7%
29.4%
46.5%
5.7%
18.1%
55.6%
7.3%
18.7%
60.6%
6.4%
21.2%
64.5%
6.9%
21.7%
59.4%
6.4%
17.7%
66.7%
6.1%
22.2%
47.4%
5.7%
14.0%
59.5%
7.0%
22.0%
50.2%
9.8%
11.8%
64.7%
8.0%
17.8%
55.6%
6.4%
13.7%
66.0%
6.9%
16.6%
63.7%
6.5%
33.5%
41.3%
4.8%
25.3%
57.2%
7.1%
17.3%
52.3%
8.0%
11.5%
62.0%
10.4%
20.8%
61.0%
4.8%
16.6%
50.2%
6.5%
21.4%
57.7%
6.9%

Uninsured
12.1%
12.9%
14.1%
11.5%
9.1%
9.4%
7.0%
8.8%
4.0%
16.8%
16.2%
5.1%
12.4%
8.7%
10.6%
5.8%
11.2%
8.0%
11.2%
10.2%
7.0%
3.6%
7.2%
5.8%
16.2%
12.5%
10.3%
9.7%
13.9%
7.9%
9.5%
12.2%
6.3%
13.6%
8.5%
8.2%
18.0%
8.8%

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

ISSUE BRIEF

10

Type of Coverage
State
Medicare Military Medicaid Employer Nongroup Uninsured
Total
Pennsylvania*
3.5%
1.9%
20.2%
60.6%
6.4%
7.4% 100.0%
Rhode Island*
3.9%
2.3%
19.3%
61.4%
8.2%
5.0% 100.0%
South Carolina
3.7%
5.5%
18.3%
51.9%
7.3%
13.3% 100.0%
South Dakota
2.9%
4.1%
12.5%
58.9%
10.0%
11.7% 100.0%
Tennessee
3.4%
3.9%
19.1%
54.2%
6.8%
12.6% 100.0%
Texas
2.3%
3.4%
14.9%
51.6%
6.4%
21.4% 100.0%
Utah
1.4%
2.4%
8.6%
66.2%
10.4%
11.0% 100.0%
Vermont*
3.8%
2.6%
23.9%
57.7%
6.6%
5.4% 100.0%
Virginia*
2.7%
9.8%
13.2%
58.6%
6.1%
9.5% 100.0%
Washington*
2.3%
5.0%
20.0%
59.1%
5.8%
7.7% 100.0%
West Virginia*
5.6%
3.3%
27.1%
51.9%
3.3%
8.8% 100.0%
Wisconsin
2.6%
2.0%
15.6%
66.2%
6.4%
7.2% 100.0%
Wyoming
2.6%
4.0%
11.1%
58.9%
8.5%
14.9% 100.0%
Total
2.9%
3.2%
19.5%
56.3%
7.0%
11.1% 100.0%
Notes: * Medicaid expansion state in 2019. Among states shown as non-expansion in 2019, Idaho, Nebraska, and Utah expanded in
2020; Missouri and Oklahoma votes approved Medicaid expansion and implementation is planned in both states for July 2021.
Individuals reporting more than one type of coverage are assigned using hierarchy of Medicare, Military (Tricare and VA),
Medicaid/CHIP, Employer-Sponsored Insurance, and Nongroup (Marketplace and off-Marketplace). Individuals reporting no coverageor coverage from Indian Health Service only are assigned as Uninsured.
Source: ASPE analysis of 2019 American Community Survey Public Use Microdata Sample (ACS PUMS).

More than half the nonelderly have employer coverage nationally, as well in most states, with lower rates in
Alaska, Arkansas, Florida, Louisiana, Mississippi, and New Mexico. The low rate of employer coverage in Florida
contributes to its high rate of nongroup coverage and – combined with the lack of Medicaid expansion – its
high percentage of uninsured. 8
Figure 7 shows the percent of persons under age 65 who were uninsured in 2019 by state. As discussed
previously, states that have not expanded Medicaid coverage had significantly higher uninsured rates.
Oklahoma and Texas had the highest uninsured rate.

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Figure 7. Nonelderly Health Insurance Coverage by State, 2019

Source: ASPE analysis of 2019 American Community Survey Public Use Microdata Sample (ACS PUMS).

DISCUSSION
The Affordable Care Act’s Effects on the Uninsured Rate
The ACA’s coverage provisions resulted in 20 million adults gaining health insurance coverage from 2010
through early 2016. These large health insurance gains occurred broadly across population groups. 9 For
instance, ASPE has previously estimated that:•••

About 3 million Black nonelderly adults gained coverage.
About 4 million Hispanic nonelderly adults gained.
About 8.9 million White non-Hispanic nonelderly adults gained coverage.

Groups that had high uninsured rates prior to 2014—including low income adults and minority populations—
had the largest coverage gains through 2016, especially in states that expanded Medicaid. 10 Almost all thedecline in the uninsured rate occurred among nonelderly adults.

Post-2016 Increases in the Uninsured Rate
Starting in 2017, the earlier reductions in the uninsured population were followed by small increases eachyear. The increase in the uninsured rate during this period can potentially be explained by several factors.
Overall, 1.9 million fewer individuals were enrolled in Medicaid and CHIP in July 2019, compared to December
2017. 11 The number of children declined by about 1.1 million and the number of adults declined by about
750,000. About 70 percent of states (36 states) experienced decreases in Medicaid and CHIP enrollment
between December 2017 and July 2019. Some of this change was associated with improvement in theeconomy (with some switching from Medicaid to employer coverage, or from Medicaid to CHIP; in fact, CHIP
enrollment rose during this period, but by less than the decline in Medicaid enrollment). But another factor
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contributing to the increase in the uninsured population was state Medicaid policies and processes that madeit more difficult to enroll, renew, and maintain coverage. 12
Other potential factors causing the increase in the uninsured population from 2017 to 2019 include reduced
funding for outreach and enrollment in the ACA Marketplaces, and changes in policies and proposals regarding
immigration, deportation, and enforcement of the public charge rule that have made some families reluctant
to enroll in subsidized health insurance. 13

COVID-19 Effects on the Uninsured
During the early months of the COVID-19 pandemic and the resulting economic recession, many researchgroups released a wide range of initial estimates of the potential shifts in health insurance in response to the
COVID-19 pandemic. 14 Medicaid enrollment and spending typically increase during economic downturns.
About 56 percent of the population has health insurance from an employer, and the increase in
unemployment during the pandemic may indicate loss of health insurance coverage as well.
The NHIS 2020 health insurance release is the first comprehensive report of health insurance coverage during
the first domestic peak of COVID-19 cases (the second quarter of 2020). However, other groups have released
survey results estimating how coverage changed during 2020. 15 The 2020 Commonwealth Fund’s Biennial
Health Insurance Survey was conducted during the first and second quarters of the year and found 12.5
percent of adults were uninsured. 16 Compared to results of the 2018 Commonwealth Fund survey, there wereno statistically significant changes in reported health insurance coverage in the first half of 2020.
In response to the COVID-19 pandemic and corresponding economic recession, the U.S. Census Bureau
developed a new experimental household survey to collect information of how people’s lives have changed
since the pandemic, including health insurance coverage. The COVID-19 Census Household PULSE Survey dataon health insurance showed a 22% relative decrease in the number of participants reporting being uninsured
at the time of interview from April 23 to May 5, 2020, to January 6 to 18, 2021, suggesting the number ofuninsured from the recent NHIS release may decline in the coming quarters. 17 However, the small sample sizesof those weekly estimates may limit their usefulness, and the NHIS data represent a more robust and validated
data source.
A driving factor for fear of increases in the uninsured was the high unemployment rate during the beginningmonths of the COVID-19 pandemic. Since spring 2020, the unemployment rate has improved, while remaining
above the pre-pandemic baseline. 18 The Congressional Budget Office estimates the number of uninsured
individuals increased from 30.5 million in 2019 to 31 or 32 million by the end of 2020. 19
Since the release of initial projections of changes in health insurance due to the COVID-19 pandemic, available
data including the new NHIS estimates suggest that the shift in coverage during 2020 was smaller thanoriginally expected. Potential factors that may explain the smaller increase in the uninsured rate include:••••

Pre-pandemic research suggests that the ACA plays a critical role in helping people maintain coverage after
job losses, which may have mitigated coverage changes due to unemployment; 20
Many of those individuals who lost some form of employment had low incomes or were in jobs without
health benefits, and either enrolled in Medicaid or were already uninsured before their job losses; 21
Economic stimuli from the Families First Coronavirus Response Act (FFCRA) and CARES Acts leading topartial economic recovery;
Employers opting to temporarily layoff or furlough their employees and continue their benefits rather than
implement permanent layoffs with loss of benefits; 22

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•
•

Individuals who lost employer coverage may have been able to enroll in coverage through a FederallyFacilitated (FFM) special enrollment period (SEP) or State-based Marketplace (SBM) SEPs, and all but one
SBM had COVID-19 SEPs starting in March 2020 for the uninsured; 23
Those enrolled in Medicaid during the COVID-19 public health emergency (PHE) cannot be disenrolledeven if their eligibility changes, as part of the maintenance-of-effort requirements states must meet toreceive increased Medicaid funding under section 6008 of the FFCRA. As a result of this policy, as well as
the pandemic effects, combined Medicaid and CHIP enrollment grew by 9.5 percent between February and
September 2020 (from 70.6 million to 77.3 million). 24

COVID-19 Effects on Surveys
The COVID-19 pandemic makes in-person data collection more challenging. 25 Beginning in March 2020, the
NHIS temporarily converted to a telephone-only survey, resulting in a varied response rate. 26 Between the firstand second quarter of 2020, the response rate dropped from 60.0 percent to 42.7 percent. While thetelephone-first strategy continued throughout 2020, in July some in-person data collection resumed in certain
areas and fully resumed in September. Even so, the NHIS response rate remained below pre-pandemic
baseline, at approximately 54 percent in the fourth quarter of 2020. In turn, the sample composition
overrepresented older adults, those with higher incomes, and those with more education, all groups that havehigher coverage rates than the general population. Populations at greater risk for being uninsured may havebeen more difficult to contact during the pandemic, which may have led to an underestimate of the uninsured
rate during this period. In addition, no single survey source on the uninsured rate is definitive, and estimatesfrom different sources typically vary to some extent. 27 The challenges associated with survey data collection
during the COVID-19 pandemic are likely to affect other surveys in addition to the NHIS, adding uncertainty
and potentially even greater variation in coverage estimates across surveys in 2020. 28

POLICY APPROACHES FOR INCREASING COVERAGE
The President signed an Executive Order on Strengthening Medicaid and the Affordable Care Act on January
28, 2021. 29 HHS is implementing a Special Enrollment Period (SEP) according to the Executive Order. The SEP
for Federally facilitated Marketplaces will be available from February 15 to May 15, 2021, for new enrollees
and current enrollees with no requirements for SEP applicants to have previously had coverage. At least
fourteen of the fifteen State-based Marketplaces (SBMs) have followed the FFM and are implementing SEPs
with the same or similar time period. 30
All but one of the 13 SBMs operating in 2020 also had 2020 COVID SEPs allowing those without insurance
coverage to enroll after the 2020 Open Enrollment Period (OEP). Comparing mid-year enrollments in 2020 vs.
2019 (which include both standard SEP and COVID-related SEP enrollment), six SBMs had a larger percentage
increase than the 30 percent increase in the FFM, showing the possibility of the new pandemic SEPs to boost
health coverage. 31
An Urban Institute survey of uninsured adults in September 2020 showed that 46 percent knew only a little ornothing at all about the ACA Marketplaces and 65 percent knew only a little or nothing about the Marketplacesubsidies. 32 Many people need assistance to enroll in coverage. Despite the availability of Marketplace Call
Centers in each state and a listing of in-person assistance on HealthCare.gov, half of consumers looking forcoverage during the 2020 open enrollment had difficulties enrolling and almost 5 million consumers couldn’t
get in-person help. 33 The most common reason given in a 2019 NHIS survey for being uninsured was that thecoverage was not affordable, with 73.7 percent answering with that reason. 34 About a quarter (25.3 percent)
did not think they were eligible for coverage, 21.3 percent said they did not need or want health insurance,and 18.4 percent thought signing up was too difficult or confusing.

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Given these findings, policies around marketing, outreach, and enrollment assistance can play an importantrole in expanding coverage. Covered California marketing and outreach in 2016 and 2017 was estimated tohave lowered premiums by 6-8 percent with more than 3:1 return on investment by enrolling a healthier risk
pool. 35 More funding for FFM marketing, outreach, and assisters could help educate uninsured adults andincrease coverage. Funding for FFM navigators and enrollment assisters was about $20 million in FY 2019 andFY 2020, roughly one-fifth of what it was in FY 2013 ($107 million) and FY 2014 ($100 million). 36 Similarly,
funding for consumer education and outreach shrank from $77 million in FY 2013 and $101 million in 2014 to$11 million in each of the years FY 2018-FY 2020. 37
Overall, the number of nonelderly uninsured is higher now than it was in 2016, and the COVID-19 pandemic
has created new threats to coverage. New policy approaches may help reduce the number of uninsured
people in the U.S., particularly for communities at the highest risk for lacking insurance – racial and ethnic
minorities, young adults, and populations with low incomes.

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NOTES
Cohen RA and Terlizzi EP. Health insurance coverage: Early release of quarterly estimates from the National HealthInterview Survey, April 2019–June 2020. National Center for Health Statistics. February 2021. Available from:https://www.cdc.gov/nchs/nhis/releases.htm.
2Cohen RA, Makuc DM, Bernstein AB, Bilheimer LT, Powell-Griner E. Health insurance coverage trends, 1959–2007:
Estimates from the National Health Interview Survey. National health statistics reports; no. 17. Hyattsville, MD: National
Center for Health Statistics. 2009. https://www.cdc.gov/nchs/data/nhsr/nhsr017.pdf.
3
Cohen RA, Terlizzi EP, Cha AE, Martinez ME. Health insurance coverage: Early release of estimates from the National
Health Interview Survey, January–June 2020. National Center for Health Statistics. February 2021. DOI:
https://dx.doi.org/10.15620/cdc:100469.
4
Dahlhamer JM, Bramlett MD, Maitland A, Blumberg SJ. Preliminary evaluation of nonresponse bias due to the COVID-19
pandemic on National Health Interview Survey estimates, April-June 2020. Hyattsville, MD: National Center for Health
Statistics. February 2021. Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/nonresponse202102-508.
5
2010: Adams PF, Martinez ME, Vickerie JL, Kirzinger WK. Summary health statistics for the U.S. population: National
Health Interview Survey, 2010. National Center for Health Statistics. Vital Health Stat 10(251). 2011.
2011: Adams PF, Kirzinger WK, Martinez ME. Summary health statistics for the U.S. population: National Health Interview
Survey, 2011. National Center for Health Statistics. Vital Health Stat 10(255). 2012.
2012: Adams PF, Kirzinger WK, Martinez ME. Summary health statistics for the U.S. population: National Health Interview
Survey, 2012. National Center for Health Statistics. Vital Health Stat 10(259). 2013.
2013: Adams PF, Martinez ME, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2013 National
Health Interview Survey. 2015. Available from: http://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2014: Adams PF, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2014 National Health Interview
Survey. 2015. Available from: http://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2015: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2015 National Health Interview
Survey. National Center for Health Statistics. 2017. Available from: http://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2016: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2016 National Health Interview
Survey. National Center for Health Statistics. 2018. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2017: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2017 National Health Interview
Survey. National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2018: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2018 National Health Interview
Survey. National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2019: Cohen RA, Cha AE, Martinez ME, Terlizzi EP. Health insurance coverage: Early release of estimates from the National
Health Interview Survey, 2019. National Center for Health Statistics. September 2020. Available from:https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm.
6
2010: Adams PF, Martinez ME, Vickerie JL, Kirzinger WK. Summary health statistics for the U.S. population: National
Health Interview Survey, 2010. National Center for Health Statistics. Vital Health Stat 10(251). 2011.
2011: Adams PF, Kirzinger WK, Martinez ME. Summary health statistics for the U.S. population: National Health Interview
Survey, 2011. National Center for Health Statistics. Vital Health Stat 10(255). 2012.
2012: Adams PF, Kirzinger WK, Martinez ME. Summary health statistics for the U.S. population: National Health Interview
Survey, 2012. National Center for Health Statistics. Vital Health Stat 10(259). 2013.
2013: Adams PF, Martinez ME, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2013 National
Health Interview Survey. 2015. Available from: http://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2014: Adams PF, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2014 National Health Interview
Survey. 2015. Available from: http://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2015: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2015 National Health Interview
Survey. National Center for Health Statistics. 2017. Available from: http://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2016: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2016 National Health Interview
Survey. National Center for Health Statistics. 2018. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2017: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2017 National Health Interview
Survey. National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.
2018: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2018 National Health Interview
Survey. National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.
1

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This count includes the District of Columbia as a state and excludes Missouri and Oklahoma, which have approved but
not yet implemented Medicaid expansion under the ACA. The other non-expansion states are Alabama, Florida, Georgia,
Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. See Kaiser
Family Foundation, State Health Facts, Status of State Action on the Medicaid Expansion Decision, available athttps://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-careact/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (downloaded
February 4, 2021).
8
Estimates of nongroup coverage are higher in the American Community Survey than in other data sources. Turner, J.,
and M. Boudreaux. "Health Insurance Coverage in the American Community Survey: A Comparison to Two Other Federal
Surveys." National Academies Press. 2010.
9
Uberoi, N et al. Health Insurance Coverage and the Affordable Care Act, 2010-2016. HHS ASPE Brief, March 3, 2016.
Accessed at: https://aspe.hhs.gov/system/files/pdf/187551/ACA2010-2016.pdf.
10Garfield, R. et al. The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the uninsured amidst
Changes to the Affordable Care Act. Kaiser Family Foundation, January 25, 2019. Accessed at: https://www.kff.org/racialequity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/.
11
Analysis of Recent Declines in Medicaid and CHIP Enrollment. Kaiser Family Foundation, November 25, 2019. Accessed
at: https://www.kff.org/medicaid/fact-sheet/analysis-of-recent-declines-in-medicaid-and-chip-enrollment/.
12
Broaddus, M. (2019). Research Note: Medicaid Enrollment Decline Among Adults and Children Too Large to Be
Explained by Falling Unemployment. Center on Budget and Policy Priorities.
13
Pollitz et al. Limited Navigator Funding for Federal Marketplace States. Kaiser Family Foundation, November 2019.
Accessed at: https://www.kff.org/private-insurance/issue-brief/data-note-further-reductions-in-navigator-funding-forfederal-marketplace-states/; Tolbert, J. et al. Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilizationof Care among Health Center Patients. Kaiser Family Foundation, October 2019. Accessed at:https://www.kff.org/medicaid/issue-brief/impact-of-shifting-immigration-policy-on-medicaid-enrollment-and-utilizationof-care-among-health-center-patients/.
14
Health Management Associates. COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, May 2020. Accessed
at: https://www.healthmanagement.com/wp-content/uploads/HMA-Updated-Estimates-of-COVID-Impact-on-HealthInsurance-Coverage-May-2020.pdf; Dorn, S. The COVID-19 Pandemic and Resulting Economic Crash Have Caused theGreatest Health Insurance Losses in American History, July 17, 2020. Families USA Accessed at:https://familiesusa.org/wp-content/uploads/2020/07/COV-254_Coverage-Loss_Report_7-17-20.pdf;
Garfield, R., et al. Eligibility for ACA Health Coverage Following Job Loss, May 13, 2020. The Kaiser Family Foundation.
Accessed at: https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/;
Garrett, B and Gangopadhyaya, A. How the COVID-19 Recession Could Affect Health Insurance Coverage, May 4, 2020.
The Urban Institute. Accessed at: https://www.urban.org/research/publication/how-covid-19-recession-could-affecthealth-insurance-coverage; Banthin J., Simpson, M., Buettgens, M., Blumberg, L., and Wang, R. Changes in healthinsurance coverage due to the COVID-19 recession: Preliminary estimates using microsimulation. Urban Institute. July 13,
2020. Accessed at: https://www.urban.org/research/publication/changes-health-insurance-coverage-due-covid-19recession.
15
Sara R. Collins, Herman K. Bhupal, and Michelle M. Doty. Health Insurance Coverage Eight Years After the ACA: Fewer
Uninsured Americans and Shorter Coverage Gaps, But More Underinsured — Findings from the Commonwealth Fund
Biennial Health Insurance Survey, 2018. February 2019. The Commonwealth Fund. Accessed at:https://www.commonwealthfund.org/sites/default/files/2019-02/PDF_Collins_2018_biennial_topline_exhibits.pdf.
16
Collins, S., Gunja, M., and Aboulafia, G. U.S. Health Insurance Coverage in 2020: A Looming Crisis in Affordability. August19, 2020. Accessed at: https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-healthcoverage-2020-biennial.
17
Estimates from the Household Pulse Survey are not directly comparable to estimates from NHIS or ACS due todifferences in methodology. For example, “don’t know” or missing survey responses are imputed in the NHIS and ACS
data, but not in the Pulse data, and the Household Pulse Survey estimates do not include children. U.S. Census Bureau.
Household Pulse Survey Data Tables. January 23, 2021. Accessed at: https://www.census.gov/programssurveys/household-pulse-survey/data.html.
Centers for Diseases Control and Prevention, National Center for Health Statistics. Health Insurance Coverage, Household
Pulse Survey. January 27, 2021. Accessed at: https://www.cdc.gov/nchs/covid19/pulse/health-insurance-coverage.htm
7

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18
U.S. Bureau of Labor Statistics. Employment Situation News Release, January 2021. Accessed at:https://www.bls.gov/news.release/archives/empsit_02052021.htm.
19
Congressional Budget Office. Federal Subsidies for Health Coverage for People Under 65: 2020 to 2030. September 29,
2020. Accessed at: https://www.cbo.gov/publication/56571.
20
Agarwal, S.D., and Sommers, B.D., Insurance Coverage after Job Loss — The Importance of the ACA during the CovidAssociated Recession, New England Journal of Medicine 383:1603-1606, October 22, 2020
(https://www.nejm.org/doi/full/10.1056/NEJMp2023312).
21
Parker, K., Minkin, R., and Bennett, J. Economic Fallout From COVID-19 Continues To Hit Lower-Income Americans theHardest, September 24, 2020. Pew Research Center. Accessed athttps://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-incomeamericans-thehardest/#:~:text=Overall%2C%2025%25%20of%20U.S.%20adults,has%20occurred%20in%20their%20household
22
U.S. Bureau of Labor Statistics. Unemployment rate falls to 6.9 percent in October 2020. TED: The Economics Daily.
Accessed at: https://www.bls.gov/opub/ted/2020/unemployment-rate-falls-to-6-point-9-percent-in-october2020.htm#:~:text=That%20was%20the%20sixth%20consecutive,and%208.8%20percent%20for%20Hispanics.
23
Rakotoniaina, A. How States are Increasing Coverage through Special Enrollment Periods. National Academy for State
Health Policy, September 28, 2020. Accessed at: https://www.nashp.org/how-states-are-increasing-coverage-throughspecial-enrollment-periods/.
24
Centers for Medicare and Medicaid Services. Medicaid and CHIP Enrollment Trends Snapshot through September
2020.Accesed at: https://www.medicaid.gov/medicaid/national-medicaid-chip-programinformation/downloads/september-medicaid-chip-enrollment-trend-snapshot.pdf .
25
Berchick, E., Mykyta, L and Stern, S. The Influence of COVID-19-related Data Collection Changes on Measuring Health
Insurance Coverage in the 2020 CPS ASEC. September 15, 2020. US Census Bureau. Accessed at:https://www.census.gov/library/working-papers/2020/demo/SEHSD-WP2020-13.html
Dahlhamer, J.M., Bramlett, M.D., Maitland, A. and Blumberg, S. Preliminary Evaluation of Nonresponse
Bias Due to the COVID-19 Pandemic on National Health Interview Survey Estimates, April-June 2020. February 2021.
Accessed at: https://www.cdc.gov/nchs/data/nhis/earlyrelease/nonresponse202102-508.pdf
26
National Center for Health Statistics, National Health Interview Survey (NHIS). 2020 NHSI. February 4, 2021. Accessed
at: https://www.cdc.gov/nchs/nhis/2020nhis.htm.
27
Uberoi, N et al. Health Insurance Coverage and the Affordable Care Act, 2010-2016. HHS ASPE Brief, March 3, 2016.
Accessed at: https://aspe.hhs.gov/system/files/pdf/187551/ACA2010-2016.pdf.
28
McIntyre, A., Brault, M.W., Sommers, B.D. Measuring Coverage Rates in a Pandemic: Policy and Research Challenges.
JAMA Health Forum. Published online October 26, 2020. Accessed at: doi:10.1001/jamahealthforum.2020.1278
29
Strengthening Medicaid and Affordable Care Act. White House Executive Order, January 28, 2021. Accessed at:https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengtheningmedicaid-and-the-affordable-care-act/.
30
See state profiles at https://www.healthinsurance.org/states/ and https://agency.accesshealthct.com/access-health-ctannounces-a-special-enrollment-period-for-uninsured-residents-due-to-ongoing-public-health-crisis.
31
Lueck, S. and Broaddus, M. Emergency Special Enrollment Period Would Boost Health Coverage Access at a Critical
Time. Center on Budget and Policy Priorities, July 30, 2020. Accessed at:https://www.cbpp.org/research/health/emergency-special-enrollment-period-would-boost-health-coverage-access-at-acritical.
Special Trends Report: Enrollment Data and Coverage Options for Consumers During the COVID-19 Public Health
Emergency. Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight,
November 2020. Accessed at: https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-OtherResources/Downloads/SEP-Report-Nov-2020.pdf.
32
Haley, JM. and Wengle E. Many Uninsured Adults Have Not Tried to Enroll in Medicaid or Marketplace Coverage. Robert
Wood Johnson Foundation, January 28, 2021. Accessed at: https://www.urban.org/research/publication/manyuninsured-adults-have-not-tried-enroll-medicaid-or-marketplace-coverage.
33
Pollitz, K. and Tolbert, J. Opportunities and Resources to expand Enrollment During the Pandemic and Beyond. Kaiser
Family Foundation, January 25, 2021. Accessed at: https://www.kff.org/health-reform/issue-brief/opportunities-andresources-to-expand-enrollment-during-the-pandemic-and-beyond/.

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34
Cha, A. and Cohen, R. Reasons for Being Uninsured Among Adults Aged 18-64 in the U.S., 2019. National HealthInterview Survey, September 2020. Accessed at: https://www.cdc.gov/nchs/products/databriefs/db382.htm.
35
Lee, P. et al. Marketing Matters: How Marketing and Outreach Builds Stable Marketplaces and Pays Off for the Federal
Government, 2017. Accessed at: https://hbex.coveredca.com/data-research/library/CoveredCA_Marketing_Matters_917.pdf.
36
Pollitz, K. and Tolbert, J. Opportunities and Resources to expand Enrollment During the Pandemic and Beyond. Kaiser
Family Foundation, January 25, 2021. Accessed at:https://www.kff.org/health-reform/issue-brief/opportunities-andresources-to-expand-enrollment-during-the-pandemic-and-beyond/.
37
Pollitz, K. and Tolbert, J. Opportunities and Resources to expand Enrollment During the Pandemic and Beyond. Kaiser
Family Foundation, January 25, 2021. Accessed at:https://www.kff.org/health-reform/issue-brief/opportunities-andresources-to-expand-enrollment-during-the-pandemic-and-beyond/.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HP-2021-02

Office of the Assistant Secretary for Planning and Evaluation

200 Independence Avenue SW, Mailstop 447D
Washington, D.C. 20201
For more ASPE briefs and other publications, visit:
aspe.hhs.gov/reports

ABOUT THE AUTHORS
Kenneth Finegold is a Senior Social Science Analyst in the Officeof Health Policy in the Office of the Assistant Secretary for
Planning and Evaluation.
Ann Conmy is a Social Science Analyst in the Office of Health
Policy in the Office of the Assistant Secretary for Planning and
Evaluation.
Rose Chu is a Program Analyst in the Office of Health Policy in the
Office of the Assistant Secretary for Planning and Evaluation.
Arielle Bosworth is an Economist in the Office of Health Policy in
the Office of the Assistant Secretary for Planning and Evaluation.
Benjamin D. Sommers is the Deputy Assistant Secretary for the
Office of Health Policy in the Office of the Assistant Secretary for
Planning and Evaluation.
SUGGESTED CITATION
Finegold K, Conmy A, Chu RC, Bosworth A, and Sommers, BD.
Trends in the U.S. Uninsured Population, 2010-2020. (Issue Brief
No. HP-2021-02). Washington, DC: Office of the Assistant
Secretary for Planning and Evaluation, U.S. Department of Healthand Human Services. February 11, 2021.
COPYRIGHT INFORMATION
All material appearing in this report is in the public domain andmay be reproduced or copied without permission; citation as tosource, however, is appreciated.
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