title: Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many.
abstract: Changes in insurance coverage over time, or "churning," may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We explored the frequency and implications of churning through surveying 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months-a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. Common causes of churning were job-related changes and loss of eligibility for Medicaid or Marketplace subsidies. Churning was associated with disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status. Even churning without gaps in coverage had negative effects. Churning remains a challenge for many Americans, and policies are needed to reduce its frequency and mitigate its negative impacts.
authors.affiliation: Benjamin D. Sommers (bsommers@hsph.harvard.edu) is an assistant professor of health policy and economics in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, and an assistant professor of medicine at Harvard Medical School/Brigham and Women's Hospital, all in Boston, Massachusetts.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.affiliation: Rebecca Gourevitch is a research assistant at the Harvard T. H. Chan School of Public Health.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gourevitch
authors.affiliation: Bethany Maylone is a project manager in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health.
authors.forename: Bethany
authors.initials: B
authors.lastname: Maylone
authors.affiliation: Robert J. Blendon is the Richard L. Menschel Professor of Health Policy and Political Analysis in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Blendon
authors.affiliation: Arnold M. Epstein is the John H. Foster Professor of Health Policy and Management at the Harvard T. H. Chan School of Public Health.
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Epstein
mesh_terms: D000328:Adult; D004608:Eligibility Determination / Q000379:methods; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D062265:Health Insurance Exchanges / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D011203:Poverty; D011795:Surveys and Questionnaires; D014481:United States
keywords: Access To Care; Health Reform; Insurance Coverage < Insurance