• Jose F Figueroa, Motunrayo Tosin-Oni, Jessica Phelan, E John Orav, and Arnold M Epstein.
• Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA. jfigueroa@hsph.harvard.edu.
• J Gen Intern Med. 2022 Aug 1; 37 (11): 279528022795-2802.

BackgroundWhile the impact of the COVID-19 recession on the economy is clear, there is limited evidence on how the COVID-19 pandemic-related job losses among low-income people may have affected their access to health care.ObjectiveTo determine the association of job loss during the pandemic with insurance coverage and access to and affordability of health care among low-income adults.DesignUsing a random digit dialing telephone survey from October 2020 to December 2020 of low-income adults in 4 states-Arkansas, Kentucky, Louisiana, and Texas-we conducted a series of multivariable logistic regression analyses, adjusting for demographics, chronic conditions, and state of residence.ParticipantsUS citizens aged 19-64 with a family income less than 138% of the federal poverty line who became newly unemployed during pandemic, remained employed during pandemic, or were chronically unemployed before and during the pandemic.Main MeasuresRates of insurance, type of insurance coverage, measures of access to/affordability of care, and food/housing security KEY RESULTS: Of 1,794 respondents, 14.5% were newly unemployed, 49.6% were chronically unemployed, and 35.7% were employed. The newly unemployed were slightly younger and more likely Black or Latino. The newly unemployed were more likely to report uninsurance compared to the employed (+16.4 percentage points, 95% CI 6.0-26.9), and the chronically unemployed (+26.4 percentage points, 95% CI 16.2-36.6), mostly driven by Texas' populations. The newly unemployed also reported lower rates of access to care and higher rates of financial barriers to care. They were also more likely to report food and housing insecurity compared to others.ConclusionsIn a survey of 4 Southern States during pandemic, the newly unemployed had higher rates of uninsurance and worse access to care-largely due to financial barriers-and reported more housing and food insecurity than other groups. Our study highlights the vulnerability of low-income populations who experienced a job loss, especially in Texas, which did not expand Medicaid.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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