Nav: Home

'Churning' following the Affordable Care Act hasn't worsened, but remains a problem

October 04, 2016

Boston, MA - About one in four low-income adults in three U.S. states have experienced changes in their health insurance coverage--known as "churning"--since the Affordable Care Act (ACA) was passed in 2014, according to a new study from Harvard T.H. Chan School of Public Health. The study suggests that, while the ACA has expanded health coverage to millions, maintaining stable coverage over time remains a challenge.

The study also found that churning has resulted in significant negative effects on health care.

The study, one of the first to look at the impacts of churning since the ACA's health coverage expansions took effect, will appear in the October 2016 issue of Health Affairs.

"We found that the ACA has not worsened the problem of churning, as some had predicted, but it hasn't fixed it either," said Benjamin Sommers, assistant professor of health policy and economics and lead author of the study. "People who switched coverage reported frequent periods when they didn't have any insurance, as well as high rates of skipping medications, having to switch doctors, and receiving low-quality care."

Previous research suggested that churning was common, particularly among lower-income individuals, even before the ACA's expanded health coverage for Americans in 2014. To find out what happened after the expansion, the Harvard Chan researchers surveyed more than 3,000 low-income adults in late 2015 in Arkansas, Kentucky, and Texas--three states that have responded in three different ways to the ACA's option of expanding eligibility for Medicaid--and they compared that information with 2013 survey data from low-income adults in those states. Kentucky chose a traditional expansion of Medicaid; Arkansas chose an expansion that enrolled Medicaid beneficiaries in private plans through the federal health care marketplace; and Texas chose not to expand. The researchers' goal was to assess the frequency of churning, what was causing it, and how it was affecting health care in each of the states.

They found that nearly 25% of respondents in each state reported that they'd switched their health coverage during the previous 12 months--similar to the percentage who had reported doing so before the ACA's coverage expansions. About 20% of the respondents who changed coverage were uninsured people who gained insurance. Other common reasons for churning included a change in a job or job-related coverage; losing eligibility for Medicaid or other federally subsidized health insurance; or inability to afford previous coverage. People in Texas were more likely to experience negative effects of coverage changes than those in Kentucky and Arkansas.

Among those who switched health coverage, nearly 20% had to change at least one doctor; 9% had to change both a primary care doctor and a specialist; 16.2% had to switch or change their prescription medications; and 33.9% either skipped doses or stopped taking medications. About half of the "churners" who experienced a gap in insurance coverage--and more than 20% of those who switched without a gap--said that their coverage change had negative effects on the overall quality of their medical care and on their health.
-end-
Other Harvard Chan School authors of the study included Rebecca Gourevitch, Bethany Maylone, Robert Blendon, and senior author Arnold Epstein.

The study was support by a grant from the Commonwealth Fund, and in part by the Agency for Healthcare Research and Quality (AHRQ; Grant No. K02HS021291).

"Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many," Benjamin D. Sommers, Rebecca Gourevitch, Bethany Maylone, Robert J. Blendon, and Arnold M. Epstein, Health Affairs, October 2016, doi: 10.1377/hlthaff.2016.0455

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives--not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.

Harvard T.H. Chan School of Public Health

Related Public Health Articles:

Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
Public health experts support federally mandated smoke-free public housing
In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities, three public health experts applaud the efforts of the US Department of Housing and Urban Development to protect nonsmoking residents from the harmful effects of tobacco exposure.
The Lancet Public Health: UK soft drinks industry levy estimated to have significant health benefits, especially among children
The UK soft drinks industry levy, due to be introduced in April 2018, is estimated to have significant health benefits, especially among children, according to the first study to estimate its health impact, published in The Lancet Public Health.
Social sciences & health innovations: Making health public
The international conference 'Social Sciences & Health Innovations: Making Health Public' is the third event organized as a collaborative endeavor between Maastricht University, the Netherlands, and Tomsk State University, the Russian Federation, with participation from Siberian State Medical University (the Russian Federation).
Columbia Mailman School Awards Public Health Prize to NYC Health Commissioner Dr. Mary T.
Dr. Mary T. Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, was awarded the Frank A.
Poor health literacy a public health issue
America's poor record on health literacy is a public health issue, but one that can be fixed -- not by logging onto the internet but by increased interaction with your fellow human beings, a Michigan State University researcher argues.
Despite health law's bow to prevention, US public health funding is dropping: AJPH study
Although the language of the Affordable Care Act emphasizes disease prevention -- for example, mandating insurance coverage of clinical preventive services such as mammograms -- funding for public health programs to prevent disease have actually been declining in recent years.
'Chemsex' needs to become a public health priority
Chemsex -- sex under the influence of illegal drugs -- needs to become a public health priority, argue experts in The BMJ this week.

Related Public Health Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...