Medicaid churn could lead to more pronounced coverage gaps

The Patient Protection and Affordable Care Act was designed to help millions of Americans receive reliable coverage that they may not have had access to before. However, some experts have also begun expressing concerns about the ways in which some of the changes the law enacted will affect people whose incomes tend to fluctuate over the course of the year.

Low-income Americans who can rely on work only sporadically – such as jobs based upon seasonal changes – have long been in a situation in which they do not always have the ability to rely on health coverage, whether it's through traditional insurance or Medicaid, according to a report from The Washington Post. Now, though, the problem could be exacerbated under the ACA's coverage mandate.

That's because in the past, those people would have simply gone without health insurance until they were eligible for Medicaid again, and do not have that option now that they are required to have some sort of plans covering them, the report said. Those who do go without insurance may face a fine.

The concept of “churn” – people bumping themselves into new income brackets temporarily – has long been a problem for low-income Americans, but the issues could vary widely if they are regularly moving between Medicaid coverage and plans obtained through the ACA's exchanges. Among these is the fact that plans can be managed by other companies, not allow access to the same doctors and so on.

How big will the issue be?
While experts concede that it's difficult to nail down exact numbers on how many people could face these difficulties under the new coverage mandate, it's generally agreed that it's a substantial portion of the population, the report said. Some estimates have the number of people who will move between Medicaid and the exchanges, or vice versa, at as much as 9 million this year alone. However, similar issues could arise thanks to the Medicaid expansion in many states nationwide that was tied into the health care law itself.

Other coverage gaps could become more prevalent in states which opted not to approve Medicaid expansion – typically those with largely Republican governments – where millions of Americans may not have incomes low enough to qualify for these programs, but also cannot afford to reasonably buy plans through private or public sources. Insurers may be able to help these people by offering low-cost coverage to them directly.