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Achieving Universal Coverage

Issue Briefs


As the Pandemic Eases, What Is the State of Health Care Coverage and Affordability in the U.S.?

Findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–June 2021

Man in front of an open sign in Los Angeles

A “We Are Open” sign is seen on the side of a restaurant as indoor dining partially reopens in Los Angeles on March 15, 2021. The COVID-19 pandemic raised concerns that millions of people would lose their job-based health coverage, but surveys and estimates based on federal data and unemployment claims suggest that coverage losses were relatively small. Photo by Frederic J. Brown/AFP via Getty Images

A “We Are Open” sign is seen on the side of a restaurant as indoor dining partially reopens in Los Angeles on March 15, 2021. The COVID-19 pandemic raised concerns that millions of people would lose their job-based health coverage, but surveys and estimates based on federal data and unemployment claims suggest that coverage losses were relatively small. Photo by Frederic J. Brown/AFP via Getty Images

To shore up an economy and health system battered during the COVID-19-induced recession, the U.S. Congress passed four major relief bills in 2020 and 2021. The Biden administration also made a number of administrative changes, including some aimed at helping people enroll in health insurance coverage.

After a year of severe job market disruption combined with a massive federal pandemic relief effort, what is the state of health care coverage and affordability in the United States?

To answer these and related questions, the survey research firm SSRS interviewed a random, nationally representative sample of 5,450 adults ages 19 to 64 from March 9 through June 8, 2021. This brief reports on the survey’s findings about current uninsured rates, pandemic-related coverage loss, and Americans’ ongoing struggles to pay their medical bills.


  • About 10 percent of adults ages 19 to 64 were uninsured during the first half of 2021. Rates were higher among Latinx/Hispanic and Black adults compared to white adults.
  • Six percent of working-age adults reported they lost their employer health coverage because of job loss related to the pandemic; of those, 67 percent gained other coverage.
  • Just under half of respondents reported they had been directly affected by the pandemic in at least one of three ways: getting COVID-19, losing income, or losing employer coverage. One-third reported lost income.
  • More than one-third of insured adults and half of uninsured adults reported they had problems paying medical bills or were paying off medical debt during the prior year. These rates were similar to those found in Commonwealth Fund surveys fielded prior to the pandemic.
  • People directly affected by the pandemic reported having medical bill and debt problems at higher rates than those not directly affected.
  • Among respondents with medical bill and debt problems, 35 percent used up all or most of their savings, 35 percent took on credit card debt, 27 percent had been unable to pay for basic necessities like food or rent, and 23 percent delayed education or career plans.

Quick Facts About the Survey

  • Included 5,450 adults ages 19 to 64.
  • Interviews were obtained through two sources: 1) a stratified address-based sample (ABS) of the population that oversampled harder-to-reach populations (i.e., low-income, Black, and Latinx/Hispanic adults), and 2) the SSRS probability-based Opinion Panel, which targeted groups with disproportionate nonresponse from the ABS sample and harder-to-reach populations. Most interviews were completed online.
  • The survey has an overall margin of error of +/– 1.8 percentage points.
  • Results were weighted to be representative of the U.S. adult (19–64) population.

Survey Findings


The survey indicates that the uninsured rate among people ages 19–64 in the first half of 2021 was 9.9 percent, a rate below those recorded in 2020 and 2019 in both federal and private surveys. Because the estimate has a margin of error of +/– 1.15 percent, the true estimate is likely between 8.9 percent and 11.1 percent.1 Uninsured rates were highest among people with low income, adults under age 50, and Latinx/Hispanic adults. Latinx/Hispanic and Black adults had higher uninsured rates than white adults.

See the box below for insights on why the U.S. adult uninsured rate may be falling.

Is the Percentage of Uninsured Americans Falling?

This survey revealed an uninsured rate among people ages 19–64 below the most recent estimates found in surveys fielded annually by the U.S. Centers for Disease Control and Prevention and the U.S. Census Bureau, as well as by private surveys conducted in 2020, including the Commonwealth Fund’s Biennial Health Insurance Survey (see How We Conducted This Survey for survey comparisons). Well-designed smaller surveys can achieve similar accuracy of large benchmark surveys, but confidence in point estimates like the uninsured rate is lower. Given the lag in federal surveys, these smaller surveys contribute to our understanding of current phenomena.

The directional change in the uninsured rate revealed by this survey is also evident in the weekly Household Pulse Survey, an experimental online survey of about 60,000 people that the Census Bureau launched in April 2020 to provide rapid data on the pandemic.2 In the most recent Household Pulse Survey, the estimated uninsured rate was 11.4 percent for adults ages 18 to 64, with a range of 10.7 percent to 12.2 percent. While that survey’s findings vary from week to week and must be viewed in the context of the survey's limitations, the overall trend in the percentage of uninsured for 2021 is below that for 2020.

There are at least four reasons why the uninsured rate may be falling:

  1. Limited pandemic-related coverage losses. The pandemic-related coverage losses were relatively small, as this survey confirms, and the majority of people who lost coverage ultimately gained other coverage.
  2. Federal restrictions on Medicaid disenrollment during the pandemic. The Families First Coronavirus Response Act, passed by Congress in March 2020, prevented states that accepted the law's temporary increase in federal Medicaid funding from disenrolling people from the program through the end of the public health emergency.3 This requirement reduced the usual number of people who leave Medicaid either because they have lost eligibility or failed to reenroll.4
  3. Marketplace special enrollment periods. Most states that run their own Affordable Care Act marketplaces opened a special enrollment period last year for any eligible person needing coverage.5 The Biden administration did the same for, the federal exchange, in January 2021, extending the period through August; all state marketplaces followed with variable time periods. The administration also reinstated deep Trump administration cuts in marketplace advertising and enrollment assistance, and it has mounted a nationwide effort to get people enrolled.
  4. Increased marketplace subsidies and COBRA premium support. The American Rescue Plan, signed into law in March 2021, included a temporary but substantial increase in marketplace premium subsidies. Zero-premium plans are available for people with the lowest incomes, and, for the first time, people with incomes above 400 percent of the federal poverty level can get subsidized coverage. Beginning in April 2021, people who experienced pandemic-related coverage loss were eligible for 100 percent premium subsidies for COBRA coverage.

The consequences of these changes are apparent in recent marketplace and Medicaid enrollment data. Combined, marketplace enrollment by people who paid their premiums in 2021 together with sign-ups during the special enrollment period are estimated at 12.4 million as of June, nearly 2 million more than a year earlier.6 Adult Medicaid enrollment climbed by 6.3 million people between February 2020 and January 2021.7


The COVID-19 pandemic triggered a deep economic recession that left millions of people unemployed and raised concerns that millions would also lose their job-based health coverage. But early Commonwealth Fund survey research and estimates based on federal data and unemployment claims suggested that coverage losses were relatively small.8

In this survey, we checked in with respondents again, finding that about 6 percent of working-age adults lost job-based coverage — whether through their own or that of a spouse, partner, or parent — since the pandemic began. Of these individuals, 67 percent gained coverage elsewhere. One of five who lost coverage got insured through another employer plan and the same percentage elected COBRA.

The Affordable Care Act’s coverage expansions also acted as an insurance safety net: 16 percent of people who lost coverage enrolled in Medicaid and 9 percent purchased a plan through the marketplaces.


Gaps in health insurance can leave people exposed to high medical bills and prevent them from getting health care when needed. That’s why people need an easy way to transition to a new source of coverage during a major life event or an economic shock. Last year we saw just how important it is to have this flexibility.

The survey asked respondents who had lost job-based coverage and did not get COBRA how long they were without insurance. More than half (54%) experienced a brief coverage gap of three or fewer months. But about 30 percent didn’t gain insurance until after four to 11 months, and 16 percent were uninsured for longer than a year. Even short gaps in coverage can leave people exposed to catastrophic health care costs, whether from COVID-19 or some other serious medical event.


The economic shutdown had a more devastating impact on certain sectors of the economy compared to others. The service industry, including restaurants and travel-related businesses, was particularly hard hit.9 Black, Latinx/Hispanic, and lower-income adults disproportionately work in such jobs. These groups were more likely to report having lost income than white or higher-income adults.


Given the economic and health crises of the past year, the survey asked Americans a series of questions about their medical bills during that time — a key measure of health care affordability the Commonwealth Fund has tracked in previous surveys.10

We find that the share of Americans who had difficulties with medical bills in 2021 is similar to the rates reported in Commonwealth Fund surveys conducted in 2018 and the first half of 2020.11 More than a third (38%) of adults reported that over the prior 12 months they or a family member had problems paying medical bills, had been contacted by a collection agency about unpaid bills, had to change their way of life to pay their bills, or were paying off medical bills and debt over time. Although uninsured people reported medical bill problems at the highest rates, 64 percent of respondents with a medical bill or debt problem said they or the family member who incurred the bill had been insured at the time (data not shown). A third of those with debt said they were paying off $4,000 or more (data not shown).


In asking people about their experiences during the pandemic, just under half reported they had been directly affected in at least one of three ways:

  • testing positive or getting sick from COVID-19
  • losing income
  • losing employer coverage.

The most frequently cited problem was lost income. Some people experienced more than one problem: for example, 23 percent reported only losing income, 5 percent reported losing income and getting COVID-19, 4 percent lost income and their employer coverage, and 1 percent had all three problems (data not shown). Black and Latinx/Hispanic adults and those with lower incomes reported at least one of these effects at higher rates than white adults and those with higher incomes (data not shown).


We did not specifically ask people who reported any one of these pandemic effects whether they had medical bill or debt problems as a result. But the survey indicates that this group of people also reported higher rates of problems with medical bills and debt than people not affected by the pandemic in these ways. Stratification by income and race/ethnicity suggests medical bill problems were more common among those affected (data not shown). People who lost income reported medical bill problems at the highest rates, especially those who also tested positive or became sick with COVID-19 or lost coverage.


People covered by either public or private insurance at the time of the survey reported problems with medical bills or debt (some may not have had coverage for the full year). For people with low income who are enrolled in Medicare or Medicaid, even small bills related to premiums, deductibles, coinsurance and copayments, or uncovered health services can place a strain on limited budgets. Especially at risk are nonelderly adults who are enrolled in Medicare because of a disability or severe illness — a group that includes some of the sickest and poorest people under age 65. And while federal Medicaid rules cap the amount of money that enrollees can spend on premiums and out-of-pocket costs, there is much variability by state.12

Private insurance, both individual-market and employer group plans, often feature significant cost-sharing. Plans requiring deductibles have become more common, and the size of deductibles has grown as well, leaving increasing numbers of privately insured people exposed to potentially high costs.13 In addition, consumers frequently face coverage denials, out-of-network surprise bills, billing mistakes, and confusing contract language regarding which services are covered or excluded.

The ACA’s minimum benefit requirements and preexisting condition protections, along with cost-sharing subsidies and limits on out-of-pocket costs, have significantly improved the coverage offered by plans sold in the individual market. But the greatest protections are aimed at people with the lowest incomes and are far less extensive for people farther up the income scale.


Even when stratifying by income level, medical bill problems were more common among Black adults compared to white adults (data not shown).


For many Americans, medical bill problems and debt are undermining economic, food, and housing security and hindering educations and careers.

Policy Implications

The survey findings provide a glimpse of insurance coverage in the United States during one of the most challenging economic periods in recent history. Its findings suggest that federal relief efforts to help people maintain their Medicaid coverage, combined with state and federal efforts to encourage people to enroll in the ACA marketplaces and in Medicaid, may have offset pandemic-related, job-based coverage losses. These public policies also may have helped lower the uninsured rate below prepandemic levels.

But the findings also show that large shares of adults continue to suffer financially when they get health care, even if they are covered by Medicare, Medicaid, or private insurance. The people most affected are those with low income and those who are Black or Latinx/Hispanic.

The findings on medical bill problems and their consequences — from ruined credit ratings to the inability to afford basic life necessities — are in line with past Commonwealth Fund surveys. People who suffered the most during the pandemic also suffered the most from medical bill problems. But the overall rates of problems reported in the survey for the past 12 months are similar to those reported by adults prior to the pandemic. This consistency suggests that cost burdens are a chronic aspect of U.S. health care that that may be exacerbated by economic and health crises, and ultimately undermine America’s overall economic well-being.

The historic No Surprises Act, which is set to go into effect in January 2022, will protect most consumers from surprise medical bills from out-of-network providers and some emergency transportation providers.14 What additional policies are needed to protect consumers?

Insure more people:

  • Make the temporary American Rescue Plan marketplace subsidies permanent to potentially reduce the number of uninsured by 4.2 million in 2022.15
  • Provide Medicaid-eligible adults in the 13 states that have not yet expanded their program a federal insurance option to cover an estimated 2.3 million uninsured people.16
  • Ensure that the millions of people who maintained their Medicaid coverage under the Families First Coronavirus Response Act don’t lose it at the end of the COVID-19 emergency. Federal and state policymakers also could consider adjustments to stabilize Medicaid coverage.17
  • Develop an autoenrollment mechanism to help people enroll and stay enrolled in comprehensive coverage. Creating a public plan as a default option would be essential to a national autoenrollment program.18

Make health insurance more comprehensive:

  • Rein in deductibles and out-of-pocket costs in marketplace plans. A bill introduced by Senator Jeanne Shaheen (D–N.H.) could eliminate deductibles for some people and reduce it for others by as much as $1,650.19
  • Combined with the reduction in deductibles and out-of-pocket costs, fix the “family coverage glitch” and lower the “employer firewall” threshold to make this better coverage available to more people currently in employer plans. Under current law, people in single-coverage employer plans with premiums that exceed 9.8 percent of income are eligible for subsidies through the marketplaces. Lowering this “firewall” affordability threshold for employer plans to 8.5 percent (the American Rescue Plan’s out-of-pocket premium cap) and fixing the coverage glitch to make this threshold apply to premiums in both single and family policies would mean that no one would have to spend more than that for their health insurance.20
  • Standardize and simplify health plans sold in the marketplaces to make it easier for consumers to understand which health services are covered.
  • Investigate the increasing reports of coverage denials in the individual market and improve the ability of consumers with public or private insurance to contest these denials.21
  • Lower the often-high prices that private insurers pay to hospitals to help reduce premiums and deductibles. This could be pursued by adding a public plan option to the marketplaces, among other approaches.22

The U.S. Supreme Court’s recent decision reaffirming the constitutionality of the Affordable Care Act paves the way for Congress to use the tools provided by the health law to not only cover the remaining uninsured but to finally make health care in the U.S. affordable to all. Doing so will be essential to the country’s postpandemic recovery and its future prosperity.

How We Conducted This Survey

The Commonwealth Fund Health Care Coverage and COVID-19 Survey was conducted by SSRS from March 9 through June 8, 2021. The survey was conducted primarily via web with telephone offered as a call-in option among a nationally representative sample of 5,450 adults ages 19 to 64. Nearly all the interviews were completed via an online survey (n=5,384), with a small percentage conducted via phone call-ins (n=66).

Interviews were obtained through two sources: 1) a stratified address-based sample (ABS) of the population, and 2) the SSRS Opinion Panel. More than half (n=3,464) of the completed interviews were obtained through ABS; 1,986 were obtained through the SSRS Opinion Panel.

The ABS sample was generated from the United States Postal Service (USPS) Computerized Delivery Sequence File (CDSF). The CDSF is a computerized file that contains information on all delivery addresses serviced by the USPS. The frame was divided into 32 strata defined by Census region, incidence of low-income households, incidence of Black residents, and incidence of Latinx/Hispanic residents. Independent random samples were drawn from each stratum. By oversampling strata that have higher incidences of the target groups relative to other strata, their representation was increased in the sample while maintaining a probability sample design.

Invitation letters were mailed in three releases to a total of 74,400 households, inviting a member of the household to participate in the survey, followed shortly by a reminder postcard. This letter provided potential respondents with a link (URL), an individual passcode to log on to the study, a QR code for easy scannable entry into the survey, and a toll-free number for respondents to call in to complete the survey with a trained interviewer.

Panelists in the SSRS Opinion Panel are recruited randomly based on nationally representative ABS design. The SSRS Opinion Panel recruits hard-to-reach demographic groups via the SSRS Omnibus survey platform. The SSRS Omnibus is a nationally representative bilingual telephone survey.

For the Commonwealth Fund Health Care Coverage and COVID-19 Survey, the SSRS Opinion Panel was used to target groups with disproportionate nonresponse from the ABS completes and harder-to-reach populations. It also was used to obtain gender balance in the final sample of completed interviews.

Both samples were weighted to compensate for sample designs and patterns of nonresponse that might bias results. The weighting ensures that the demographic profile of the sample matches the profile of the target population.

The margin of error for the entire sample is +/ – 1.8 percentage points. The response rate for the ABS portion of the survey was 6.1 percent. The completion rate for the SSRS Opinion Panel was 46.8 percent and the composite response rate, which includes the response rate for the Opinion panel recruitment, was 1 percent.

Estimates of U.S. Uninsured Rates

Current uninsured rate Population Time frame Sample design
Commonwealth Fund Health Care Coverage and COVID-19 Survey23 9.9%
[8.9%, 11.1%]
U.S. adults ages 19–64 March–June 2021 Address-based sample and SSRS multimode panel24
Household Pulse Survey (June 2021)25 11.4%
[10.7%, 12.2%]
U.S. adults ages 18–64 June 9–June 21, 2021 U.S. Census Bureau Master Address File (MAF) sample26
National Health Interview Survey (NHIS) (Jan.–June 2020)27 13.4%
[12.3%, 14.6%]
U.S. adults ages 18–64 January–June 2020 Crosssectional household interview survey28
Commonwealth Fund Biennial Health Insurance Survey (Jan.–June 2020)29 12.5%
[11.2%, 13.9%]
U.S. adults ages 19–64 January–June 2020 Dual-frame, RDD telephone survey
Urban Institute Coronavirus Tracking Survey (May 2020)30 11.3% U.S. adults ages 18–64 May 2020 Ipsos probability-based panel31
Current Population Survey (CPS) (2019)32 11.1%
[10.8%, 11.4%]
U.S. adults ages 19–64 January–December 2019 Probability-selected sample; personal and telephone interviews33


The authors thank Robyn Rapoport, Erin Czyzewicz, Rob Manley, and Kiersten Millward of SSRS; and David Blumenthal, Eric Schneider, Melinda Abrams, Chris Hollander, Jen Wilson, Paul Frame, Jesse Baumgartner, and Arnav Shah, all of the Commonwealth Fund.


1. The Commonwealth Fund Health Care Coverage and COVID-19 Survey has a maximum margin of sampling error of +/– 1.8 percentage points at the 95 percent confidence interval. As estimates get further from 50 percent in either direction, the margin of sampling error decreases. This is why the estimated uninsured rate has a smaller margin of sampling error.

2. National Center for Health Statistics and U.S. Census Bureau, “Health Insurance Coverage: Household Pulse Survey,” last reviewed June 30, 2021.

3. Sarah Sugar et al., Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic (Assistant Secretary for Planning and Evaluation, Office of Health Policy, Apr. 2021); and Sara Rosenbaum, Morgan Handley, and Rebecca Morris, Winding Down Continuous Enrollment for Medicaid Beneficiaries When the Public Health Emergency Ends (Commonwealth Fund, Jan. 2021).

4. Sugar et al., Medicaid Churning, 2021.

5. Madeline O’Brien and Sabrina Corlette, “State Action Related to COVID-19 Relief: Expanding Access to Affordable Coverage Options,” Commonwealth Fund, last updated June 28, 2021.

6. Centers for Medicare and Medicaid Services, “2021 Marketplace Special Enrollment Period Report,” fact sheet, July 14, 2021; Centers for Medicare and Medicaid Services, “Effectuated Enrollment: Early 2021 Snapshot and Full Year 2020 Average,” June 5, 2021; Andrew Sprung, “Obamacare Mid-Year Enrollment Is Likely Up 19% over Past Peak,” XPOSTFACTOID (blog), June 10, 2021; and Charles Gaba, “Breaking: CMS Announces Over 1.24 Million Have Enrolled Via HC.Gov SEP So Far; #GetCovered Thru 8/15,” (blog), June 14, 2021.

7. Centers for Medicare and Medicaid Services, December 2020 and January 2021 Medicaid and CHIP Enrollment Trends Snapshot (CMS, June 2021).

8. Sara R. Collins et al., An Early Look at the Potential Implications of the COVID-19 Pandemic for Health Insurance Coverage — Commonwealth Fund Health Care Poll: COVID-19, May–June 2020 (Commonwealth Fund, June 2020); Paul Fronstin and Stephen A. Woodbury, How Many Americans Have Lost Jobs with Employer Health Coverage During the Pandemic? (Commonwealth Fund, Oct. 2020); Paul Fronstin and Stephen A. Woodbury, “Update: How Many Americans Have Lost Jobs with Employer Health Coverage During the Pandemic?,” To the Point (blog), Commonwealth Fund, Jan. 11, 2021; and Jessica Banthin et al., Changes in Health Insurance Coverage Due to the COVID-19 Recession: Preliminary Estimates Using Microsimulation (Urban Institute, July 2020).

9. Fronstin and Woodbury, How Many Americans?, 2020.

10. Sara R. Collins, Munira Z. Gunja, and Gabriella N. Aboulafia, U.S. Health Insurance Coverage in 2020: A Looming Crisis in Affordability — Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2020 (Commonwealth Fund, Aug. 2020).

11. Collins et al., U.S. Health Insurance Coverage, 2020; and Sara R. Collins, Herman K. Bhupal, and Michelle M. Doty, Health Insurance Coverage Eight Years After the ACA: Fewer Uninsured Americans and Shorter Coverage Gaps, But More Underinsured (Commonwealth Fund, Feb. 2019).

12. Sophie Beutel, Munira Z. Gunja, and Sara R. Collins, How Much Financial Protection Do Marketplace Plans Provide in States Not Expanding Medicaid? (Commonwealth Fund, June 2016).

13. Collins et al., U.S. Health Insurance Coverage, 2020; Sara R. Collins, David C. Radley, and Jesse C. Baumgartner, State Trends in Employer Premiums and Deductibles, 2010–2019 (Commonwealth Fund, Nov. 2020); and Sherry A. Glied and Benjamin Zhu, Catastrophic Out-of-Pocket Health Care Costs: A Problem Mainly for Middle-Income Americans with Employer Coverage (Commonwealth Fund, Apr. 2020).

14. Jack Hoadley and Kevin Lucia, “Putting Surprise Billing Protections into Practice: Biden Administration Releases First Set of Regulations,” To the Point (blog), Commonwealth Fund, July 14, 2021.

15. The White House, “Fact Sheet: The American Families Plan,” Apr. 28, 2021; and Jessica Banthin et al., What if the American Rescue Plan’s Enhanced Marketplace Subsidies Were Made Permanent? Estimates for 2022 (Urban Institute, Apr. 2021).

16. D. Keith Branham, Christie Peters, and Benjamin D. Sommers, Estimates of Uninsured Adults Newly Eligible for Medicaid If Remaining Non-Expansion States Expand (Assistant Secretary for Planning and Evaluation, Office of Health Policy, May 2021); Sherry A. Glied and Richard G. Frank, “Extend Marketplace Coverage to Insure More People in States That Have Not Expanded Medicaid,” To the Point (blog), Commonwealth Fund, June 10, 2021; John Holahan et al., Filling the Gap in States That Have Not Expanded Medicaid Eligibility (Commonwealth Fund, June 2021); Sara Rosenbaum, Morgan Handley, and Rebecca Morris, “How the Experience of Insuring Legal Immigrants Can Offer Insights into Insuring Eligible Residents in Medicaid Nonexpansion States,” To the Point (blog), Commonwealth Fund, June 3, 2021; and Sara Rosenbaum, “Confronting the Consequences of National Federation of Independent Business v Sebelius to Insure the Poor,” Milbank Quarterly Opinion, Apr. 13, 2021.

17. Sugar et al., Medicaid Churning, 2021.

18. Linda J. Blumberg, John Holahan, and Jason Levitis, How Auto-Enrollment Can Achieve Near-Universal Coverage: Policy and Implementation Issues (Commonwealth Fund, June 2021).

19. Improving Health Insurance Affordability Act of 2021, S. 499, 117th Cong. (2021); and Linda J. Blumberg et al., From Incremental to Comprehensive Health Insurance Reform: How Various Reform Options Compare on Coverage and Costs (Urban Institute, Oct. 2019).

20. Timothy S. Jost, “Eliminating the Family Glitch,” To the Point (blog), Commonwealth Fund, May 18, 2021; and Matthew Buettgens and Jessica Banthin, Changing the “Family Glitch” Would Make Health Coverage More Affordable for Many Families (Urban Institute, May 2021).

21. Karen Pollitz and Daniel McDermott, Claims Denials and Appeals in ACA Marketplace Plans (Henry J. Kaiser Family Foundation, Jan. 2021).

22. Linda J. Blumberg et al., Comparing Health Insurance Reform Options: From “Building on the ACA” to Single Payer (Commonwealth Fund, Oct. 2019); John Holahan, Michael Simpson, and Linda J. Blumberg, What Are the Effects of Alternative Public Option Proposals (Urban Institute, Mar. 2021); and Sherry A. Glied and Jeanne M. Lambrew, “How Democratic Candidates for the Presidency in 2020 Could Choose Among Public Health Insurance Plans,” Health Affairs 37, no. 12 (Dec. 2018): 2084–91.

23. Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–June 2021.

24. SSRS, “SSRS Opinion Panel,” n.d.

25. NCHS and Census, “Household Pulse Survey,” 2021.

26. U.S. Census Bureau, “Source of the Data and Accuracy of the Estimates for the Household Pulse Survey – Phase 3.1,” n.d.

27. Robin A. Cohen et al., Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, Jan-June 2020 (National Center for Health Statistics, Feb. 2021).

28. National Center for Health Statistics, “About the National Health Interview Survey,” last reviewed Sept. 16, 2020.

29. Collins et al., U.S. Health Insurance Coverage, 2020.

30. Michael Karpman, Stephen Zuckerman, and Graeme Peterson, Adults in Families Losing Jobs During the Pandemic Also Lost Employer-Sponsored Health Insurance (Urban Institute, July 2020).

31. Urban Institute, “Health Reform Monitoring Survey: HRMS Frequently Asked Questions,” n.d.

32. Katherine Keisler-Starkey and Lisa N. Bunch, Health Insurance Coverage in the United States: 2019 (U.S. Census Bureau, Sept. 2020).

33. U.S. Census Bureau, “CPS Methodology,” n.d.

Publication Details



Sara R. Collins, Vice President, Health Care Coverage and Access, The Commonwealth Fund

[email protected]


Sara R. Collins, Gabriella N. Aboulafia, and Munira Z. Gunja, As the Pandemic Eases, What Is the State of Health Care Coverage and Affordability in the U.S.? Findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–June 2021 (Commonwealth Fund, July 2021).