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State Efforts to Promote Continuity of ACA Coverage

A new culture of health care has been ushered in by the Patient Protection and Affordable Care Act (ACA) but Americans with income fluctuations, such as those with multiple part-time jobs, may experience shifts in coverage. Those transitions would require the affected people to "churn" between Medicaid and private insurance, a process that could affect affordability and continuous access to care.

To address these issues, states have been working to implement programs that could reduce the impacts of such transitions. In the most recent issue of the Journal of Health Politics, Policy and Law, Princeton University researchers outline some potential programs and the states that have implemented them.

A release from the university quotes lead author Heather Howard, a lecturer in public affairs at the Woodrow Wilson School, as saying, "This is a complicated issue as all states are dealing with different health care landscapes and political realities. The best system will be one that works to ensure continuous access to care and care for those whose income fluctuations cause them to transition between different coverage programs."

With Chad Shearer, a lecturer in public affairs at the Wilson School, Howard explains in the report how these emerging approaches take into account the desire for state flexibility and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and state budgets.

The state options, as outlined in the report, are as follows.

*State funding to "wrap around" qualified health plans. This plan reduces out-of-pocket expenses for consumers by using state dollars to cover premiums and co-pays for lower-income individuals purchasing qualified health plans. Given state resource constraints, the researchers write, this plan is unlikely in all but a few states that might be willing and able to spend additional dollars to provide these services. The plan addresses affordability but not continuous access to care. Massachusetts and Vermont are considering this option.

*New programs for specific populations. One option under the ACA, the Basic Health Program, allows states to provide more generous financial and benefit protections for individuals making less than 200 percent of the federal poverty level. (This figure is adjusted based on family size, but, for a single-household consumer that income would be $22,980 and $39,060 for a family of three.) This option might be less attractive, the researchers write, in smaller states because it could reduce the number of people in the individual insurance market and might drive up prices for those remaining. Also, this plan won't be available until 2015. Minnesota is the only state currently pursuing a Basic Health Program for 2015.

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