Since the Affordable Care Act (ACA) was passed in 2014 about one in four low-income adults in three U.S. states have experienced changes in their health insurance coverage--known as "churning", according to a new study from Harvard T.H. Chan School of Public Health.
The study found that churning has resulted in significant negative effects on health care.
‘The common reasons for churning included a change in a job or job-related coverage; losing eligibility for Medicaid or other federally subsidised health insurance; or inability to afford previous coverage.’
"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."
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. 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.