As many as 7.7 million workers lost jobs with Employer-sponsored Insurance (ESI) during the COVID-19 pandemic, according to a new study from the Employee Benefit Research Institute (EBRI), The W.E. Upjohn Institute for Employment Research, and the Commonwealth Fund.

The study also found that 6.9 million dependents were covered by ESI through these workers, and manufacturing workers were most affected by loss of jobs with ESI. 

In response to the COVID-19 pandemic, most states imposed lockdown orders that closed many workplaces and dramatically slowed US economic activity in the spring of 2020. The result was a massive increase in unemployment, which peaked in April at 14.7%. During the 15 weeks from mid-March to the end of June, Americans filed nearly 49 million new claims for unemployment benefits.

The strong link between employment and health insurance coverage has important implications for Americans’ insurance coverage and access to health care, as ESI is the most common form of health insurance in the United States.

“This study illustrates how the country’s predominantly job-based health insurance system leaves workers and their families at risk of losing coverage during a severe economic downturn,” said Sara Collins, Commonwealth Fund vice president for Healthcare Coverage, Access, and Tracking. “Unlike prior recessions, the reforms of the Affordable Care Act are a safety net for many who lose coverage. But the law is now at risk of repeal before the Supreme Court, just when Americans need it most.” 

In March 2019, 69% of the 152 million workers ages 16 and older had ESI, meaning that 175 million workers and their dependents had coverage. But if millions of workers and their dependents have lost ESI during the pandemic, the result would be increased enrollment in COBRA (Consolidated Omnibus Budget Reconciliation Act) continuous coverage, Affordable Care Act marketplace plans, and Medicaid, as well as an increase in the number of uninsured. 

Employees are Not Equally Impacted

The pandemic-related lockdowns affected some industries and groups of workers more severely than others. Total job losses in manufacturing were roughly proportional to employment—manufacturing accounted for 10% of pre-pandemic employment and 12% of unemployed workers in June. But because manufacturing has one of the highest rates of ESI coverage at 66%, it accounted for a greater proportion of loss of jobs with ESI (18% of lost jobs with ESI and 19% of potential ESI coverage loss when dependents are included). 

Nearly 3.3 million workers in accommodation and food services became unemployed between February 2020 and June 2020, or 30% of the industry’s workforce. However, only 25% of workers in that industry had ESI pre-pandemic, so only 7% of accommodation and food service workers lost jobs with ESI as a result of shutdowns.

Similarly, retail trade accounted for 10% of pre-pandemic employment and 14% of unemployed workers in June. But because only 40% of workers in retail trade had ESI pre-pandemic, these workers accounted for only 12% of lost jobs with ESI and 11% potential ESI coverage loss including dependents. 

“Demographics also play an important role. Workers ages 35-44 and 45-54 bore the brunt of ESI-covered job losses, in large part because workers in these age groups were the most likely to be covering spouses and other dependents,” said Paul Fronstin, Director of EBRI’s Health Research and Education Program. “The adverse effects of the pandemic recession also fell disproportionately on women. Although women made up 47% of pre-pandemic employment, they accounted for 55% of total job losses.”