Context: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population, and millions of Americans lost employer-sponsored health insurance during the COVID-19–induced economic downturn. We examine public opinion toward universal health coverage policies in this context.

Methods: Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic victim losing employer-sponsored coverage during COVID-19. As a secondary outcome, we examine the effect of these exposures on support for the Affordable Care Act.

Findings: We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p<0.01) with greater M4A support. Experimental exposure to the vignette increases M4A support by 6 pp (p=0.05). When expansion of the ACA is added as a response option, experimental priming still increases support for M4A, but direct experience of insurance loss is associated with greater support for the ACA than for M4A.

Conclusions: In the context of the COVID-19 pandemic, situational framings can induce modest change in support for M4A, especially among individuals without well-formed preferences. However, real-world health insurance losses are associated with larger differences in support for M4A and with greater support for existing safety net policies such as the ACA. The large-scale loss of employer-based insurance during COVID-19 offers the potential for new structural coalitions supportive of universal coverage.

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Supplementary data