• Posted April 30, 2025

Medicaid 'Unwinding' Caused Drop In Insurance Coverage Among Working-Age Adults

The “unwinding” of Medicaid that occurred after the end of the COVID-19 pandemic has left more working-age Americans without health insurance, a new study says.

The uninsured rate increased to 11.5% from 11.1% between March 2023 and March 2024, researchers reported April 28 in the Annals of Internal Medicine.

That small shift means that hundreds of thousands more Americans lost their health insurance, given that there are 207 million working-age people in the U.S.

“The uninsured rate among working-age adults increased 1 year after Medicaid unwinding, primarily driven by decreases in Medicaid and employer-sponsored coverage, despite an increase in Marketplace enrollment,” concluded the research team led by senior investigator Dr. Rishi Wadhera, a cardiologist at Beth Israel Deaconess Medical Center in Boston.

During the pandemic, the federal government prevented states from taking people off Medicaid rolls, researchers said in background notes.

That policy led to a record low uninsured rate of 9.6% among working-age adults. That policy expired at the end of March 2023.

After that came Medicaid “unwinding,” in which states started scouring their rolls to remove people who no longer were eligible for coverage under the low-income public insurance program.

To see how unwinding affected insurance rates, researchers analyzed data from a U.S. Census Bureau annual survey on working Americans. The data included nearly 165,000 people 19 to 64 who self-reported their insurance status.

Results showed that between 2023 and 2024:

• Coverage from employer-sponsored plans declined from 61.1% to 60.2%.

• Medicaid coverage declined from 14.5% to 13.9%.

• Medicare coverage declined from 3.6% to 3.4%.

At the same time, coverage increased in policies purchased through Affordable Care Act Marketplaces to 5.4% from 4.6%, and it remained around 2.8% among non-Marketplace plans, researchers found.

In particular, Medicaid unwinding caused a rise in uninsured rates among 19- to 44-year-olds, researchers said.

White and mixed-race people experienced an increase in uninsured rates, but not Asian, Black or Hispanic adults, results show.

The unwinding also caused an increase in uninsured rates among people with a high school diploma or less education, but not among people who attended college.

“Younger adults, those with lower educational attainment, and combined-race groups experienced the most pronounced insurance loss,” researchers wrote. “In contrast, uninsured rates among low-income and Black and Hispanic adults remained stable, potentially reflecting the effect of targeted outreach efforts, including record investments in insurance navigators for underserved communities.”

Overall, researchers concluded: "These findings highlight the critical need to mitigate further insurance loss among working-age adults, especially as policymakers consider whether to extend or terminate additional pandemic-era protections (for example, enhanced premium tax credits).”

More information

KFF has more on Medicaid unwinding.

SOURCE: Annals of Internal Medicine, April 28, 2025