Medicaid enrollment rose sharply during the coronavirus pandemic, with nearly 10 million Americans joining the public health coverage program for the poor through January, a government report released Monday shows.
Eighty million people — more than ever before in the program’s history — now carry Medicaid coverage, for which states and the federal government share the cost. The new figures demonstrate the program’s increasingly important role not just as a safety net, but as a pillar of American health coverage, with fully a quarter of the population covered under it.
“The purpose of Medicaid is for times like this, when there is an economic downturn” said Peggah Khorrami, a researcher with Harvard Chan T.H. School of Public Health, who has studied the program’s enrollment increases during the pandemic. “As people are losing jobs, that’s where Medicaid comes in and we get people insured that way.”
The Affordable Care Act transformed Medicaid from a targeted health care benefit meant to help certain groups of people — expectant mothers, for example, and those with disabilities — to a much wider program that provides largely free coverage to most people below a certain income threshold. The exception is in 12 states, mostly in the South, that have resisted expanding Medicaid under the health law to cover all adults with income up to 138 percent of the poverty level, which would be $17,774 for an individual this year.
The expansion of Medicaid in most states since the bulk of the A.C.A. took effect in 2014, though, has proved important during the pandemic, creating a public source of coverage for the newly unemployed that did not exist a decade ago. Adult enrollment in Medicaid grew twice as quickly as child enrollment last year, suggesting widespread job loss related to the pandemic created a huge group of newly eligible adults.
“In past economic downturns there has been substantial growth in Medicaid enrollment but it was concentrated among children,” said Rachel Garfield, co-director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured. “This time, it’s interesting we’re seeing much of the enrollment happening among adults.”
Ms. Garfield also noted that Medicaid coverage has spiked much faster during this recession than in previous downturns. Fewer than 4 million Americans joined the program in 2009 at the beginning of the Great Recession.
There may also have been increased interest among uninsured Americans who were eligible for Medicaid before but only decided to enroll because of heightened health concerns during the pandemic.
“The increase we are seeing is exactly how Medicaid works: the program steps in to support people and their families when times are tough,” Chiquita Brooks-LaSure, the Biden administration official who oversees the Medicaid program, said in a statement.
Medicaid enrollment had been declining in the years leading up to the pandemic. More than a million children lost coverage between December 2017 and June 2019, a trend that had rattled health care advocates. Many attributed the changes to new rules during the Trump administration that made it more difficult to enroll in the benefits.