Access to healthcare is an ongoing problem in Alabama and across the United States. In the early days of the Affordable Care Act (ACA), the number of Americans without health insurance declined. However, the problem was never fully solved. Between 2010 and 2016, the number of uninsured Americans dropped from 46.5 million (17.8%) to 26.7 million (10%). U.S. Census data suggests slightly higher statistics (49.9 million in 2010 and 28.1 million in 2016), with the trend remaining the same. 

Unfortunately, in 2017, that trend reversed. In 2017 and 2018 the number of uninsured Americans increased by several hundred thousand per year. Without medical insurance many people lack access to healthcare services. The absence of routine care, which promotes a healthy, vibrant lifestyle, can be a leading factor in chronic medical conditions which plague many in society. Alabama residents are insured at a slightly higher rate than the U.S. average. Still, according to Alabama Public Health (APH), access to healthcare is the number one health-related concern voiced by people in the state. 

These problems are widespread, but impact some populations more severely than others. A survey conducted by The Commonwealth Fund revealed that adults aged 19-64 with lower incomes were significantly more likely to be uninsured. About 58% of the uninsured in that age group had incomes below 200% of the poverty level. Latino adults are also disproportionately likely to be uninsured, making up about 18% of the working-age population and about 35% of the uninsured. 

Thus, lack of medical insurance and access to healthcare were serious problems in the U.S.–especially for lower-income Americans–before coronavirus jolted the economy and the workforce. 

Impact of Covid-19 on Access to Medical Insurance

In 2018, 49% of Americans were covered by employer healthcare plans. While those rates are slightly lower in many southern states, employer-sponsored health insurance is still the most common scenario. In Alabama and Tennessee, 47% of the population were covered through work. In Mississippi, the rate was 43%. 

But, that was before coronavirus made its entrance.

Among the start of shutdowns around the country in March and the end of May, more than 42 million people filed new unemployment claims. While the federal government stepped in with some extended and enhanced unemployment benefits to help displaced workers through the pandemic, theres no easy fix for the loss of employer-sponsored healthcare. 

The number of Americans who became or will become uninsured due to coronavirus-related job loss isnt yet clear. In mid-May, the Economic Policy Institute (EPI) estimated that 16.2 million U.S. workers had likely lost health coverage due to Covid-19-related economic fallout. Millions of new unemployment claims have been filed since, and that figure doesnt consider dependents who were also covered on those plans. 

Options for the Newly Uninsured

Losing employer-sponsored coverage is tough, especially at a time when access to quality healthcare is critical and the economy is uncertain. Many people in this situation have options, but its important to be aware of them and act quickly. 

Dependent Coverage

Some displaced workers may have the option of picking up coverage through a family member. If youre married and were previously covered on separate employer policies, you may be able to add the newly-unemployed spouse to the others coverage. But, there are less-obvious possibilities to explore, including a special enrollment period. For instance, if your spouse declined employer health insurance because he or she was covered on your policy, your loss of coverage may trigger a special enrollment period. Similarly, if youre under the age of 26 and have lost employer coverage, your parents may be able to add you to their policy.


The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) creates a right to continuation coveragefor most employees. That means that when you lose or leave your job, you have a right to keep your medical insurance for a time. While its a temporary solution, COBRA coverage can help avoid a gap in insurance. 

Nevertheless, COBRA isnt a fix for everyone. The most significant barrier is the high cost of coverage. In the current crisis, two other factors may put COBRA coverage out of reach. First, the law applies only to companies with at least 20 employees. There are about 20 million U.S. companies with fewer than 20 employees, and small businesses have been hit hard by the pandemic. So, many displaced workers will not be eligible.

Another drawback is that the obligation to offer COBRA coverage terminates if the company goes out of business.

Your employer is required to notify you if you are eligible for COBRA coverage and to provide information about your next steps. Despite that, many businesses have been thrown into turmoil by pandemic shutdowns. Do not assume youre not eligible. If you have lost employer coverage and have not received COBRA information, ask your designated human resources administrator. Consequently, the window to sign up is limited.

Marketplace Insurance

The Commonwealth Fund study mentioned above concluded that many uninsured people could have qualified for subsidies through the marketplace established by the ACA. Normally, you can only purchase insurance through the marketplace during an open enrollment period once each year. But, people who have recently lost coverage through an event like divorce or job loss may qualify for a special enrollment period. However, that special enrollment period is limited. If you miss it, you may be locked out until the next open enrollment period, so its important to act quickly. 


Since the state did not accept federal funding to expand Medicaid coverage, medicaid will not be an option for most citizens in Alabama. The same is true for Mississippi and Tennessee. For that reason, eligibility is strictly limited. Yet, depending on income, coverage may be available for children, or for those with disabilities who may have previously been covered on a family members employer plan.

In addition, both Alabama and Tennessee have explored expanding Medicaid since the pandemic started. So, if you dont have another alternative, its a good idea to check back for possible changes in eligibility.

Explore Your Options Immediately after Loss of Insurance

Options for medical coverage vary depending on a wide range of factors. Sorting through them can be daunting. When youre facing the stress of job loss, economic uncertainty, and a global health crisis, it may be even more overwhelming. Many options are strictly time-sensitive. For that reason, you can not afford to delay. If you’re facing unmanageable debt made worse by the COVID crisis, reach out to our office today to see how we can help you.

Monica Blanding
Written by Monica Blanding

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