Evidence map›Paper›PMID 40577007›Full record

ArticleJAMA health forum2025

Insurance Churn and the COVID-19 Pandemic.

Sarah P Shubeck, Emily Crawford, Matthew J Notowidigdo

Abstract read
In one paragraph

Article in JAMA health forum, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Sarah P ShubeckDepartment of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois.
Emily CrawfordBooth School of Business, University of Chicago, Chicago, Illinois.
Matthew J NotowidigdoBooth School of Business, University of Chicago, Chicago, Illinois.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Many individuals in the US face a high risk of losing their health insurance coverage and experiencing insurance churn, especially those enrolled in Medicaid. Prior research has found that the risk of losing insurance coverage remains high in the US even after the Patient Protection and Affordable Care Act significantly reduced the number of uninsured individuals. Objective: To estimate whether the Families First Coronavirus Response Act (FFCRA) decreased insurance churn. Design, Setting, and Participants: This study used 2 quasi-experimental approaches: an interrupted time series approach and a difference-in-difference approach. Both approaches use individual-level data from the Medical Expenditure Panel Survey from January 2015 to December 2022. In the difference-in-difference analysis comparing individuals with Medicaid to individuals with private health insurance coverage, the probability that insured individuals aged 2 to 64 years lose insurance over the next 12 months before and after the FFCRA was estimated. Data were analyzed from January to November 2024. Main Outcomes and Measures: Primary outcome was the share of insured individuals who lost insurance coverage over the next 12 months. This measure was defined for all insured individuals and defined separately for individuals with Medicaid and for individuals with private insurance coverage. Results: The sample included 96 473 individuals. Of these, 46 779 (49.7%) were male, and the mean (SD) age was 31.9 (18.1) years. In the interrupted time series analysis, the FFCRA was associated with a reduction in insurance churn by 2.06 percentage points (β = -0.021; 95% CI, -0.024 to -0.018; P < .001). In the difference-in-difference analysis, the FFRCA reduced Medicaid churn by 5.51 percentage points (β = -0.055; 95% CI, -0.060 to -0.050; P < .001). Combining these estimates, 65.0% (95% CI, 54.8-75.3) of the reduction in insurance churn came from the reduction in Medicaid churn. Conclusions and Relevance: In this study, the FFCRA was associated with a significantly decreased risk of losing health insurance. Without the FFCRA, an estimated 2.94 million individuals with Medicaid would have lost insurance coverage each year during the COVID-19 public health emergency.

Indexed as

COVID-19Insurance CoverageInsurance, HealthMedicaidMedically UninsuredAdolescentAdultChildChild, PreschoolFemaleHumansInterrupted Time Series AnalysisMaleMiddle AgedPandemicsPatient Protection and Affordable Care Act

Identifiers

PMID40577007
PMCPMC12205398

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.