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HMA Updates Forecast of COVID-19 Impact on Medicaid, Marketplace, Uninsured

Health Management Associates’ (HMA) updated analysis projects the potential impact of the COVID-19 pandemic on health insurance coverage and cost by state through 2022. The analysis provides deeper insights into how health insurance coverage is estimated to take years to more closely resemble pre-COVID-19 coverage levels.

The analysis forecasts Medicaid enrollment could increase by 5 to 18 million by the end of the year and costs could grow by at least $11 billion in 2020. Depending on the speed of the economic recovery, Medicaid enrollment by the end of 2022 could be 1-5 million higher than year-end 2019. Total state and federal costs to cover the additional Medicaid population could range from $18 billion to $127 billion between 2020 and 2022.

A team of HMA Medicaid experts, health economists, and data analysts calculated the approximate change in health insurance coverage and cost by state as a result of the economic disruptions primarily driven by COVID-19. HMA utilized three unemployment rate scenarios – ranging from a peak unemployment rate of 20-28% – to estimate the impact on Medicaid, the ACA Marketplaces, employer provided insurance, and the uninsured.

In addition to estimates of Medicaid program costs through 2022, HMA’s update includes new estimates reflecting the magnitude and duration of the economic downturn and revised assumptions regarding how enrollment could change over time. The additional analysis includes an evaluation of the more than 30 million people who have filed for unemployment insurance since February, the relationship between industry and type of health insurance, and a review of expected type and timing of insurance coverage enrollment after job loss, differentiated by state of residence, personal and family income, and family status. HMA released its initial analysis April 3.

HMA’s updated analysis projects that Marketplace enrollment will edge up 1-5 million by the end of 2020. The combination of the Medicaid and Marketplace enrollment increases this year, juxtaposed with a projected decline in employer-sponsored coverage of 5-27 million, helps explain why the increase in the number of people uninsured (1-5 million by year’s end) is not steeper. A disproportionate share of the newly uninsured are in non-expansion states. Enrollment in the individual Marketplace is projected to see significant turnover, as people will both enter and exit due to job losses and have associated changes in income.

HMA Updated Estimates of COVID Impact on Health Insurance Coverage, May 2020