Fact check: How many people have lost their health care benefits during the pandemic?

The issue: North Carolina Attorney General Josh Stein said that “27m Americans” have lost their employer-based health insurance in recent weeks, according to his social media posts.

Why we’re checking this: Stein shared this claim on both Twitter and Facebook. It aims to convince people the state needs to expand Medicaid.

What you need to know: Stein’s claim is based on estimates by a Kaiser Family Fund study that is considered reliable among experts. There were already more than 100,000 North Carolinians who fell in the Medicaid “coverage gap” before the COVID-19 pandemic: they were not eligible for Medicaid but did not make enough money to qualify for subsidies for marketplace plans. Because of increasing unemployment, especially in lower-wage jobs, experts expect even more North Carolinians to become uninsured.

Medicaid expansion has been a hotly contested topic in the legislature for a while now, and the dispute is a major reason the state never approved a new budget for the past year. More than 40 million Americans impacted by the COVID-19 pandemic have claimed unemployment benefits in the past 10 weeks — and as a result, lost their employees’ health care programs. Now, some Americans are left scrambling to find an insurance plan.

In a tweet and Facebook post, Democratic Attorney General Josh Stein called for Medicaid expansion in North Carolina, saying 27 million Americans have lost their insurance, and “many” Americans who do not qualify for Medicaid or a subsidized insurance plan will be left without insurance.

“NC needs to expand Medicaid more than ever. 27m Americans have lost their employer-based health insurance in recent weeks,” he said in the tweet. “While some qualify for Medicaid or subsidized insurance, many do not. During a pandemic, insurance is critical. Expand Medicaid!”

Stein linked to an Axios article that reports on a study by the Kaiser Family Foundation. Stein spokesperson Laura Brewer said the tweet was based on this article.

How many Americans have lost their employer-based insurance?

The Kaiser Family Foundation study estimated “that nearly 78 million people lived in a family in which someone lost a job” between March 1 and May 2. Of those people, nearly 27 million people “could potentially lose” their employer-based insurance.

These numbers are estimates based on unemployment data, said Pam Silberman, professor of health policy and management at the UNC Gillings School of Public Health, in a phone interview with The N&O.

“All of it is contingent on the estimates being correct about the number of people who have lost jobs,” Silberman said, “which they’re getting from the unemployment data, and they’re modeling to guess as to who is going to lose employer-sponsored data and who might not. Kaiser has done these before, they’re very reliable, lots of people quote them.”

David Anderson, a research associate at Duke University’s Margolis Center for Health Policy, said in a phone interview that the Kaiser study has similar results to a study done by the Urban Institute which estimated that anywhere from 25 million to 43 million people would lose their employer-based coverage. That’s if unemployment rates rise 15-25% over the next several months.

“Although the 27 million is an estimate until we get actual data on health insurance loss, their methods seem sound,” said Marisa Domino, professor of health policy and management at the UNC Gillings School of Public Health, in an email interview.

Until the actual data is out on health insurance loss, these are just estimates. Stein’s claim is still in the right ballpark, Anderson said.

What’s the connection to Medicaid expansion?

When the Affordable Care Act, which is also known as Obamacare, was passed in 2010, states were given the option to expand Medicaid, so people below 133% (or 138%, depending on the methodology used to calculate income) of the federal poverty level could qualify. As of January 2020, 37 states, including the District of Columbia, have expanded Medicaid.

In order to cover the cost of Medicaid expansion, the federal government pays for 90%, and the state government 10%. Legislators opposed to expanding Medicaid argue that they cannot count on the federal government to continue to pay their percentage of the share forever, and that expanding Medicaid would add to the national debt.

North Carolina is one of the 14 states that have not expanded Medicaid.

People in states that have not expanded Medicaid must be in the “right category” of needy people to be eligible for traditional, Silberman said.

Those categories include low-income people who are pregnant, are parents with children, have disabilities and are elderly. Low-income adults without children usually do not qualify for Medicaid in states where it has not been expanded.

People whose incomes are between 100% and 400% of the federal poverty line are eligible for subsidies to help purchase coverage plans from the Health Insurance Marketplace, which the federal government operates in most states. But people whose income is 100% of the federal poverty line or lower do not qualify for subsidies. Since these people do not qualify for subsidies or Medicaid, they are in what is known as the “coverage gap.”

According to a Kaiser study using data from 2018, there are about 194,000 North Carolinians in the coverage gap. This study was before the COVID-19 pandemic. With so many people losing their jobs, Anderson said it is likely that more people will fall into that gap.

“Layoffs have been heavily clustered in low-wage occupations so far,” Anderson said, “so in North Carolina, there is going to be a very large cohort of individuals who can not qualify for Medicaid, even if they can jump through all the hoops.”

The CARES Act, the coronavirus relief bill, covers COVID-19 testing for uninsured people, but it does not cover treatment, Silberman said. As of right now, she said she does not know of any other programs available to help people who have found themselves in the coverage gap.

Silberman said being uninsured could deter sick people from seeking treatment for fear of expensive medical bills.

“Medicaid expansion helps because once people get coverage, they have health insurance coverage, they can go in both for testing, and they’re not afraid of the outstanding bills they would have if they have healthcare needs.”

This story was produced by The News & Observer Fact-Checking Project, which shares fact-checks with newsrooms statewide. It was edited by Politics Editor Jordan Schrader and Managing Editor Jane Elizabeth. Submit a suggestion for what we should check, or a comment or suggestion about our fact-checking, at bit.ly/nandofactcheck.

Our sources:

“Coronavirus likely forced 27 million off their health insurance” by Axios

Email interview with Marisa Domino, professor of health policy and management at the UNC Gillings School of Public Health on May 24, 2020

Email interview with Don Taylor, professor of public policy at the Duke Sanford School of Public Policy on May 22, 2020

“Eligibility for ACA Health Coverage Following Job Loss” by the Kaiser Family Foundation

“How the COVID-19 Recession Could Affect Health Insurance Coverage” by the Urban Institute

“Jobless America: the coronavirus unemployment crisis in figures” by The Guardian

Phone interview with David Anderson, a research associate at Duke University’s Margolis Center for Health Policy on May 22, 2020

Phone interview with Pam Silberman, professor of health policy and management at the UNC Gillings School of Public Health on May 22, 2020

“Status of State Medicaid Expansion Decisions: Interactive Map” by the Kaiser Family Foundation