Both before and after the Affordable Care Act (ACA), the US health insurance system is characterized by fragmentation. Pre-ACA, this fragmentation included major coverage gaps, causing significant periods of coverage interruption, especially for lower-income people. The ACA does not end the problem of churning among sources of public financing, but it does hold the potential for enabling people to move among sources of coverage rather than go without insurance. Several strategies for reducing coverage churn exist, but none is foolproof and all are in their early stages. Thus the ability of issuers to participate across multiple public financing arrangements and to offer stable provider networks becomes crucial to achieving continuity of care. Interviews with nine companies involved in developing or operating multimarket strategies confirm the feasibility of this approach while revealing major challenges, especially the challenge of finding providers willing to treat members regardless of the source of coverage. Strategies for increasing multimarket plans and networks represent one of the great areas of future policy and operational focus.
[1]
S. Rosenbaum,et al.
Medicaid and marketplace eligibility changes will occur often in all states; policy options can ease impact.
,
2014,
Health affairs.
[2]
Matthew Buettgens.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States
,
2013
.
[3]
S. Rosenbaum,et al.
Using Medicaid to buy private health insurance--the great new experiment?
,
2013,
The New England journal of medicine.
[4]
S. Rosenbaum,et al.
Creation of state basic health programs would lead to 4 percent fewer people churning between Medicaid and exchanges.
,
2012,
Health affairs.
[5]
S. Rosenbaum,et al.
Issues in health reform: how changes in eligibility may move millions back and forth between medicaid and insurance exchanges.
,
2011,
Health affairs.
[6]
C. Schoen,et al.
Churn, churn, churn: how instability of health insurance shapes America's uninsured problem.
,
2003,
Issue brief.