How to Preserve Healthcare Coverage for Millions
Lifting paperwork requirements during the COVID health emergency prevented large-scale disenrollment.
- By
- June 30, 2025
- CBR - Health Care
The White House and congressional Republicans have targeted Medicaid—the health-insurance program relied upon by more than 50 million of America’s low-income and other vulnerable citizens—for potential spending cuts. The Congressional Budget Office has estimated that the One Big Beautiful Bill Act, passed by the House of Representatives in May, would result in 7.8 million fewer people enrolled in the program by 2034.
Even before the legislative push to reduce Medicaid’s ranks, however, millions of participants were getting bounced from the program each year over failure to comply with its administrative requirements.
Research by University of Chicago’s Sarah P. Shubeck, Chicago Booth PhD student Emily Crawford, and Booth’s Matthew Notowidigdo finds that the right policy adjustments can substantially reduce “insurance churn”—short-term coverage loss due to administrative requirements, changes in eligibility, or other factors. The researchers studied the effects of the Families First Coronavirus Response Act, a law enacted in spring 2020 whose provisions included immediately halting Medicaid disenrollments. During the time this continuous coverage was in effect—it ended in spring 2023—the law prevented nearly 3 million people from losing Medicare coverage annually, they estimate.
“The greater meaning seems to be that a lot of churn is due to paperwork issues rather than fundamental nonqualification,” says Notowidigdo.
Although the Affordable Care Act, passed in 2010, has significantly reduced the number of residents with no health insurance, Americans still face a high risk of losing coverage at some point, typically when enrollees are obligated to verify income, family status, and residence in order to maintain coverage, the researchers write.
Such requirements take a particularly large toll on Medicare participants. Prior to the FFCRA, the program’s 12.6 percent churn rate was more than double the 5.6 percent rate for individuals with private, employer-based coverage.
A policy that kept people insured
When the Families First Coronavirus Response Act stopped Medicaid disenrollments, the share of enrollees losing coverage dropped significantly, bringing the churn rate much closer to that of those with private coverage.
To test whether the pandemic-era law reduced churn, Shubeck, Crawford, and Notowidigdo conducted two studies using the Medical Expenditure Panel Survey, which includes data on individuals and healthcare providers across the United States. In particular, they analyzed MEPS data on insurance coverage for 96,000 people between January 2015 and December 2022. They defined insurance churn as the share of individuals beginning a given month with health coverage who then became uninsured for at least one month over the following year.
In one analysis, the researchers assume that absent passage of the FFCRA, the churn trend would have been unchanged, and that the law was therefore responsible for any deviation. In another, they compared churn rates among people with Medicaid, on which the FFCRA had a direct effect, with those on private insurance, for which the law did not apply.
Both studies point to a reduction in insurance churn, but the comparison of Medicaid and private insurance highlights the FFCRA’s role. It found that there were similar trends in insurance churn between the two groups in the years prior to the FFCRA’s passage. As soon as the law came into effect, however, the Medicaid churn rate decreased by 5.5 percentage points relative to that for private insurance. The difference then stabilized for the remainder of the sample period.
Combining their two studies, Shubeck, Crawford, and Notowidigdo estimate that Medicaid accounted for roughly 65 percent of the overall decline in churn after the FFCRA was enacted. Given that approximately 53 million mostly low-income individuals were enrolled in Medicaid in the year before the FFCRA was passed, the lower churn rate helped 2.94 million Medicaid participants avoid losing insurance coverage each year from 2020 to 2023, the researchers estimate.
Having people join and leave Medicaid’s rolls can be costly for the healthcare system, since it encourages them to defer or delay preventative treatment and can add to administrative expenses. Therefore, even when some legislators want to reduce Medicaid enrollment, they may not want to use insurance churn to do so. At other times, the policy goal might be keeping as many people enrolled as possible.
By providing insight into how public policy can reduce insurance churn, the research opens the door to further study of how such changes affect healthcare use, outcomes, and long-term health disparities.
Sarah P. Shubeck, Emily Crawford, and Matthew Notowidigdo, “Insurance Churn and the COVID-19 Pandemic,” JAMA Health Forum, June 2025.
More from Chicago Booth Review
More from Chicago Booth
Your Privacy
We want to demonstrate our commitment to your privacy. Please review Chicago Booth's privacy notice, which provides information explaining how and why we collect particular information when you visit our website.