Background: 

Unemployment associated with the coronavirus disease 2019 (COVID-19) pandemic was linked to financial insecurity and disruptions in access to health care.

Objective: 

To explore whether expanded access to Medicaid mitigated the likelihood of health and non-health financial hardship associated with pandemic-linked job loss.

Design: 

We estimate linear regression models comparing differences in the levels of outcomes attributable to pandemic-linked joblessness in Medicaid expansion and nonexpansion states.

Observations: 

A total of 20,281 adults aged 19–64 were in the 2021 National Financial Capability Study.

Measures: 

Our key exposure was job loss, layoffs, and furloughs, attributable to the COVID-19 pandemic. Outcomes under evaluation include indicators of health care access and household financial health.

Results: 

Relative to persons reporting pandemic-linked unemployment in nonexpansion states, adults experiencing pandemic-linked job loss in expansion states were less likely to report as uninsured [−6.2 percentage points (PPs); 95% CI: −10.8, −1.6; P < 0.01], having unpaid medical bills (−4.3 PP; 95% CI: −8, −0.6; P < 0.05), having unmet medical needs due to cost (−5.3 PP; 95% CI: −10.1, −0.5; P < 0.05), and having calls from debt collection agencies (−6.9 PP; 95% CI: −10.6, −3.1; P < 0.01). Patterns consistent with Medicaid acting as a safety net for the adverse financial effects of job loss were more pronounced for middle-income households.

Conclusions: 

In economic downturns, such as the COVID-19 crisis, Medicaid can help insulate households from diminished health care access and financial distress associated with job loss.