Impact of Medicaid 'Unwinding' on Insurance Coverage Among Working-Age Adults

The recent process known as Medicaid 'unwinding,' which took place after the conclusion of COVID-19 relief measures, has led to a notable increase in the number of working-age Americans losing their health insurance. According to a new study published in the Annals of Internal Medicine, the uninsured rate among adults aged 19 to 64 climbed from 11.1% in March 2023 to 11.5% in March 2024.

This incremental rise translates to hundreds of thousands more individuals without coverage, considering the U.S. working-age population is approximately 207 million. The research team, led by Dr. Rishi Wadhera from Beth Israel Deaconess Medical Center, found that the increase was primarily driven by reductions in Medicaid and employer-sponsored insurance, despite an upswing in Marketplace plans.

During the pandemic, federal policies shielded many from losing Medicaid coverage by preventing states from disenrolling individuals. This kept the uninsured rate low at around 9.6%. However, with the expiration of these policies at the end of March 2023, states began reviewing and removing ineligible individuals from Medicaid rolls — a process dubbed 'unwinding.'

Scientists analyzed survey data from nearly 165,000 working-age Americans to assess how insurance coverage changed. Results indicated a decline in employer-based coverage from 61.1% to 60.2%, Medicaid participation from 14.5% to 13.9%, and Medicare from 3.6% to 3.4%. Conversely, enrollment through ACA Marketplaces increased from 4.6% to 5.4%, and non-Marketplace coverage remained steady around 2.8%.

The study highlighted that younger adults, those with lower educational attainment, and individuals from multiple racial backgrounds experienced the most significant coverage losses. Notably, uninsured rates rose among White and mixed-race populations, while Asian, Black, and Hispanic adults saw stable coverage levels, possibly due to targeted outreach efforts.

Overall, researchers emphasized the importance of policy interventions to prevent further erosion of health coverage among vulnerable groups as ongoing debates surround potential extensions or rollbacks of pandemic-era protections. The findings underscore the need for strategies to mitigate insurance loss and ensure access to healthcare for working-age Americans.

Source: https://medicalxpress.com/news/2025-04-medicaid-unwinding-coverage-age-adults.html