Many of the 42 million people who have lost jobs during the COVID-19 pandemic also lost employer-based health insurance. The uninsured rate was 26.3% among newly unemployed people as of April, compared with 10.7% for those with jobs. The recent $2 trillion bailout bill did not provide health insurance coverage or subsidies.

People who live in states that expanded Medicaid eligibility under the Affordable Care Act (ACA) may be able to obtain insurance through this government program even while receiving unemployment benefits. Under expanded eligibility, adults with a median annual income at or below 138% of the poverty level ($26,347 for a family of three and $17,236 for an individual) can qualify for coverage. Those who live in states without Medicaid expansion face greater hurdles: only pregnant women, people with disabilities, or parents/caretakers of children are eligible for Medicaid and their income must fall at or below 40% of the poverty level-just $8,532 for a family of three. Childless adults are ineligible, regardless of income. The difference between nonexpansion and expansion states is reflected in the uninsured rate among the unemployed: 38.4% in nonexpansion states compared with 22.1% in expansion states.

The COVID-19 crisis exposes the folly of an employer-based health insurance system, contend Woolhandler and Himmelstein in an online April 7 opinion piece in Annals of Internal Medicine. Writing that "the current tsunami of job and coverage losses along with a heightened risk for severe illness demands action," the authors call on nonexpansion states to reconsider and on the federal government to authorize Medicare coverage for people eligible for unemployment benefits. The situation may worsen dramatically if the Trump administration's renewed challenge to the ACA, filed June 26, is upheld by the Supreme Court.-Carol Potera