Children’s Coverage Vulnerabilities With Loss of a Parent’s Employer-Sponsored Insurance

* Abbreviations: ACA — : Affordable Care Act COVID-19 — : coronavirus disease ESI — : employer-sponsored insurance FPL — : federal poverty level In addition to the devastating health effects of the coronavirus disease (COVID-19) pandemic, the United States is experiencing the highest rates of unemployment since the Great Depression.1 One important and overlooked consequence of unemployment is the loss of employer-sponsored insurance (ESI) coverage for children whose parents lose their jobs. It is estimated 27 million US adults will become uninsured because of unemployment and lose ESI during the pandemic.2 During the pandemic, >4 out of 10 parents with children <19 years old reported they or a family member lost a job, work hours, or work-related income, which is slightly more than for childless adults.3 Two out of 5 adults in newly unemployed households reported having obtained their health insurance coverage from that employer. More than half of US children are covered by ESI,4 including 49% of children with preexisting conditions who have special health care needs.5 For lower-income and minority families, this loss of ESI during the COVID-19 pandemic will likely intensify already existing health disparities for children. Unemployment during the pandemic has differentially affected low-income and minority populations in the US. Children of low-wage workers are at risk for resulting coverage loss, including the 25% of children from families with incomes <138% of the federal poverty level (FPL) … Address correspondence to Lois K. Lee, MD, MPH, Division of Emergency Medicine, 300 Longwood Ave, Boston Children’s Hospital, Boston, MA 02115. E-mail: lois.lee{at}childrens.harvard.edu