Health insurance loss during COVID-19 increases support for universal health coverage


Fox AM, Choi Y, Lanthorn H, Croke K. Health insurance loss during COVID-19 increases support for universal health coverage. Journal of Health Policy, Politics, and Law. 2021.


Context: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. An estimated 15 to 27 million Americans have lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion towards universal health coverage policies in this context.

Methods: Using data collected through an online survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on stated support for Medicare-for-All (M4A) in two ways. First, we examine the association of pandemic-related health insurance loss with M4A support. We consider this change in insurance status a ‘structural frame.’ Second, we make introduce a ‘situational frame,’ experimentally priming some respondents with a vignette of a sympathetic victim losing employer-sponsored health coverage during COVID-19. With this, we estimate the impacts of this ‘vicarious insurance loss’ on M4A support. In both cases, we examine how political party affiliation moderates the effect.

Findings: Nearly a quarter (22%) of respondents reported personal health insurance loss in the 6 months preceding the survey. We find that directly experiencing recent health insurance loss is strongly associated (10-15 pp, p<0.01) with greater M4A support. Experimental exposure to the vignette increases M4A support by 6 pp (p=0.05), largely by shifting respondents declaring they “don’t know” about their support into supporters. We find no moderating influence of political-party affiliation in the survey experiment. However, party identification does modify the association between insurance loss and M4A support; Republicans, who report much lower levels of baseline M4A support, are more likely than Democrats to have higher M4A approval if they have lost insurance recently.

Conclusions: In the context of the COVID-19 pandemic, situational framings can induce modest change in attitudes among individuals who do not have well-formed preferences about M4A. However, the effects of real world events such as job and health insurance loss are associated with larger changes, including among self-identified partisans. This suggests that the large scale loss of employer-based insurance offers the potential for new coalitions supportive of policies to expand health insurance coverage.

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Last updated on 10/28/2021