- Consumers' movement between health insurance plans, or “churning,” has been an issue since before the Affordable Care Act and continues to be today, concluded researchers from the Harvard T.H. Chan School of Public Health.
- The authors suggested in their paper, which appeared in Health Affairs, that although the ACA has expanded coverage to millions, the lack of stability in coverage necessitates policies to reduce the frequency of the issue and mitigate the negative impacts.
- The findings indicate the negative impacts of churning include healthcare – an issue that affects not only patients, but physicians who increasingly have a stake in patient outcomes.
While the issue of churning has become extremely visible due to frustrations with the ACA's volatile health insurance marketplaces, the ACA has not actually made churn any worse, according to the Health Affairs study lead author Benjamin D. Sommers, MD, PhD.
However, the ACA has certainly provided a new arena in which the issue plays out.
Churning is often a result of job-related changes and changes in eligibility for Medicaid or Marketplace subsidies, the study said, but as noted by Kaiser Health News, churning is gaining particular attention as it pertains to marketplace customers being forced to change plans. This is occurring because so many plans have either been pulled from the market by retreating insurers, or have died along with a failed co-op, or have had to increase costs. Recent estimates suggested at least 1.4 million people, and possibly as many as 2.5 million, will find their 2016 plans no longer available for next year.
On one hand, that may arguably be the nature of the market, and the Obama administration has loudly promoted ACA consumers' freedom to shop around for plans. However, frequent changing of health plans has implications unlike changing service providers in other industries. “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,” Sommers wrote.
The study found that among those who switched coverage, almost 20% had to change at least one doctor; 9% had to change a primary care doctor and a specialist; 16.2% had to change prescription medications; and 33.9% skipped doses or stopped medications.
Other factors, noted KHN, include the interruptions to patient/doctor relationships that include trust and physicians' understanding patients that can not always be summed up and passed along in a health record.