Health insurance, labor market shocks, and mental health during the first year of the COVID-19 crisis

Abstract

We use the Census Household Pulse Survey (HPS) to examine employment and earnings loss, health insurance, and hardships related to physical and mental health and health care, as well as food insecurity and difficulty meeting expenses, during the first year of the COVID-19 pandemic. Pandemic job loss is strongly associated with uninsurance in the HPS. Moreover, among those who were not employed due to a pandemic economic reason such as a business closure, we find substantial regression-adjusted differences in hardship by insurance status, especially in the domains of mental health, mental health care and financial difficulties (food insufficiency and difficulty paying usual expenses). The uninsured generally, and uninsured job losers especially, were at high risk of untreated or under-treated mental health symptoms. We also find evidence among non-employed persons of substantial differences by gender and race/ethnicity in uninsurance, mental health symptoms and unmet needs for mental health care.