RWJF and Urban reports examine coverage for vulnerable populations
Posted on June 14, 2012 | No Comments
Every year, almost one-third of the 96 million people who will receive either Medicaid, or new subsidies to purchase insurance through an exchange, will change their source of coverage as a result of changes in their income and employment, according to a new report from the Robert Wood Johnson Foundation (RWJF) and the Urban Institute. This “churning” of people from one source of insurance coverage to another has long occurred in public programs like Medicaid and the Children’s Health Insurance Program (CHIP), but the Affordable Care Act’s (ACA) Medicaid expansion and subsidized coverage in exchanges will significantly expand its occurrence.
The authors explain how states could systematically fight churning, including through Medicaid premium assistance and the Basic Health Program. However, since such efforts can only reduce but not eliminate forced changes in coverage, the report also describes how states could limit the harm experienced by families in transition.
A second RWJF report also authored by Urban Institute researchers examines the ACA’s ability to protect all individuals who purchase insurance through the small group and nongroup markets, especially those who have many health needs, and therefore high costs. The authors say that the ACA will dramatically reduce problems in these markets by establishing benefit standards, requiring readily understandable and comparable information from plans, and prohibiting many long-standing market practices designed to avoid enrolling those with high health needs and to limit the payment of legitimate claims. However, the authors find that the proposed approach to implementing two key ACA requirements—“essential health benefits” and insurance plan actuarial value— even in combination with the law’s additional insurance protections, may not ensure that the highest-need consumers receive predictable and adequate insurance protection.