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.
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:

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.
Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.
Bloomberg American Health Initiative releases special public health reports supplement
With US life expectancy now on the decline for two consecutive years, the Bloomberg American Health Initiative is releasing a supplement to Public Health Reports, the scholarly journal of the US Surgeon General.
Data does the heavy lifting: Encouraging new public health approaches to promote the health benefits of muscle-strengthening exercise (MSE)
According to a new study in the American Journal of Preventive Medicine, almost 75 percent of US adults do not comply with public health guidelines recommending two or more muscle-strengthening exercise (MSE) sessions a week, with nearly 60 percent of the population doing no MSE at all.
The Lancet Public Health: Moderate carbohydrate intake may be best for health
Low-carb diets that replace carbohydrates with proteins and fats from plant sources associated with lower risk of mortality compared to those that replace carbohydrates with proteins and fat from animal sources.
More Public Health News and Public Health Current Events

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

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...