title: Mitigating the effects of churning under the Affordable Care Act: lessons from Medicaid.
abstract: Through a combination of three needs-based public programs--Medicaid, the Children's Health Insurance Program, and tax credits for purchasing private plans in the new marketplaces--the Affordable Care Act can potentially ensure continuous coverage for many low- and moderate-income Americans. At the same time, half of individuals with incomes at less than twice the poverty level will experience a form of "churning" in their coverage; as changes occur in their life or work circumstances, they will need to switch among these three coverage sources. For many, churning will entail not only changes in covered benefits and cost-sharing, but also in care, owing to differences in provider networks. Strategies for mitigating churning's effects are complex and require time to implement. For the short term, however, the experiences of 17 states with policies aimed at smoothing transitions between health plans offer lessons for ensuring care continuity.
authors.affiliation: School of Public Health Law and Health Services, George Washington University, USA. sarar@email.gwu.edu
authors.forename: Sara
authors.initials: S
authors.lastname: Rosenbaum
authors.forename: Nancy
authors.initials: N
authors.lastname: Lopez
authors.forename: Mark
authors.initials: M
authors.lastname: Dorley
authors.forename: Joel
authors.initials: J
authors.lastname: Teitelbaum
authors.forename: Taylor
authors.initials: T
authors.lastname: Burke
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Miller
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics / Q000331:legislation & jurisprudence; D003266:Continuity of Patient Care / Q000191:economics / Q000331:legislation & jurisprudence*; D017047:Cost Sharing / Q000191:economics / Q000331:legislation & jurisprudence; D004608:Eligibility Determination / Q000191:economics / Q000331:legislation & jurisprudence* / Q000379:methods; D035082:Federal Government; D005380:Financing, Government / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods; D005544:Forecasting; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence*; D062265:Health Insurance Exchanges / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007182:Income / Q000145:classification; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000331:legislation & jurisprudence; D011203:Poverty; D012959:Socioeconomic Factors; D013219:State Government; D013221:State Health Plans / Q000191:economics / Q000331:legislation & jurisprudence; D013660:Taxes; D014481:United States