Expanding Health Care Coverage


RAND Corporation

Funding Area

Expanding Health Care Coverage


November 2021


The COVID-19 pandemic–related recession and resulting job loss raised concerns that health insurance coverage could erode substantially, but those fears have not materialized. This NYHealth-funded report from the RAND Corporation examines the factors that contributed to relatively stable rates of coverage during the pandemic.

The analysis found that temporary provisions played an outsized role in stabilizing coverage in 2020 and will continue to play a large role in 2021.

  • This analysis and emerging evidence from other sources suggest that temporary policies—notably, continuous Medicaid enrollment and furlough coverage—are major contributing factors to the success of the health insurance safety net.
  • The temporary extension and enhancement of Advance Premium Tax Credits (APTCs) likely contributed to enrollment stability in 2021.
  • Workers’ ability to retain job-based coverage after being laid off may have been a substantial factor in holding national insurance rates steady.
  • On their own, the Affordable Care Acts’s coverage provisions might not have fully prevented insurance loss during the COVID-19 pandemic.
  • For New York State, extending and enhancing APTCs—two temporary policies that legislators have proposed making permanent through the Build Back Better Act—could offset most of the decline in insurance that would be expected because of elevated unemployment in 2021, even without continuous Medicaid enrollment.

Read the report.