“If you like your health care plan, you can keep it!” For years this simple, effusive rallying cry has been the informal slogan animating liberal opposition to a single-payer, Medical-for-All system. Initially popularized during the Obama administration’s reform efforts in 2009, the mantra has since been taken up, ironically enough, by those most hostile to real reform.

The problem with “If you like your health care plan, you can keep it,” and its misleading intimation of personal freedom and choice, has always been the same: in a system where health care for millions is actually contingent on their employment status, many lack either freedom or choice when it comes to how they’re insured against illness or injury — if indeed they’re lucky enough to be insured at all. Many employers are at liberty to switch employee plans at will and those who lose their jobs are liable to lose their coverage entirely.

More strongly than any other single moment in recent American history, the coronavirus pandemic is revealing the deep dysfunction of a system in which health and work are so intimately bound together. As a new report published by the DC-based Urban Institute rather ominously illustrates, as many as forty-three million Americans — and possibly even more — could lose their health insurance as the measures taken in response to the pandemic create spiraling unemployment on a scale unseen since the Great Depression.

Unemployment projections for the months ahead vary.

Almost thirty million workers filed unemployment claims between the middle of March and the end of April with the report’s authors citing short-term forecasts that place the national unemployment rate somewhere between 15 and 20 percent by June. Other forecasts are still more dire. Ratings agency S&P expects unemployment to hit 19 percent this month. James Bullard, president of the Federal Reserve Bank of St. Louis, predicts it may reach as high as 30 percent — which would greatly exceed both the 10 percent figure reached in October 2009 and the 25 percent unemployment rate hit in 1933 during the worst ravages of the Great Depression.

Taking this uncertainty into account, the Urban Institute’s analysts provide separate estimates as to how many workers will be thrown off their employer-sponsored health insurance (ESI) under different unemployment scenarios. If unemployment hits 20 percent, just over forty-three million Americans will lose their ESI — the figure being a staggering fifty-six million should it reach 25 percent. Though some will qualify for Medicaid or be able to purchase individual coverage for themselves (income permitting), the report’s authors find that millions will become completely uninsured even in less pessimistic unemployment scenarios. Ultimately, as many as 7.5 million Americans could lose insurance entirely in the event the unemployment rate climbs to 25 percent.

Despite years of concerted opposition from industry groups and leading Democratic politicians, a poll conducted by Morning Consult last month found that support for a single-payer, Medicare-for-All system is now at record numbers. Its popularity notwithstanding, some Democrats in the House are currently pushing to include protections sought by the private health insurance lobby in the next coronavirus relief package even as companies like UnitedHealth, Humana, and Cigna report continued profits.

“We’re not expecting a material financial impact,” Cigna executive Matt Manders recently told Axios. Maybe not, but tens of millions of ordinary Americans are — and America’s profit-driven health care system is showing once again that it is not their friend.