An estimated 5.4 million Americans lost their health insurance within the first few months of 2020 amid mass layoffs during the coronavirus pandemic.
More Americans became uninsured between February and May than over any year in history, according to a report from nonpartisan consumer advocacy group Families USA, which compiled state-by-state reports estimating Covid-19's impact among workers under 65.
In that time, at least 22 million Americans lost their jobs or left the workforce. The public health crisis also has stripped roughly 16 million workers and their families from employer-provided health plans, according to the Economic Policy Institute.
"Despite these historic coverage losses, no Covid-19 legislation yet signed into law has made a serious effort to protect comprehensive health insurance," Families USA reported.
"Policymakers know that millions of people are losing employer-based coverage," it added. "But they do not know how many people are becoming uninsured and how many are retaining coverage by shifting to insurance offered by a spousal employer, Medicaid, or the individual insurance market.
"Policymakers need to know now about the magnitude of coverage losses as they decide whether and, if so, how the next Covid-19 legislation will restore and maintain comprehensive health insurance."
The report found that the spike in uninsured Americans – adding to an estimated 84 million people who are already uninsured or underinsured – is 39 per cent higher than any previous annual increase, including the most recent surge at the height of the recession between 2008 and 2009 when nearly 4 million non-elderly Americans lost insurance.
Nearly half of the recently uninsured are in just five states: California, Florida, New York, North Carolina and Texas.
In eight states, 20 per cent or more adults are uninsured. In Texas, that figure is nearly 30 per cent. Nearly five million people in the state are uninsured.
A quarter of Florida adults also do not have insurance, according to the report.
Nearly a quarter of residents in states that have expanded Medicaid through the Affordable Care Act lost insurance. But that figure nearly doubled to 43 per cent in the 13 states that have not expanded the federal health program for families earning lower wages, including Florida, North Carolina and Texas.
Definitive coverage data won't be available until 2021 once the federal government begins publishing health insurance estimates for the previous year.
The report arrives as new daily infections across the US are surging, with states regularly breaking their daily case count records and rising hospitalisations and deaths are straining healthcare workers
Health coverage has become a central campaign issue, with Democratic presidential challenger promising an expansion of the Affordable Care Act, exploring the addition of a "public option" after pressure from Medicare for All supporters and Bernie Sanders. Meanwhile, Donald Trump is challenging the landmark healthcare legislation at the US Supreme Court after stripping away vital components from the law – including non-discrimination protections for women and LGBT+ people – without offering an alternative to offer coverage to Americans.
Congress also is weighing additional relief measures to expand health coverage, with debate over COBRA subsidies and Medicare eligibility.