PRINCETON, N.J.—A new culture of health care has been ushered in by the Patient Protection and Affordable Care Act (ACA) but, for some, it may be even more complicated than some reports suggest. Americans with income fluctuations, such as those with multiple part-time jobs, may experience shifts in coverage, requiring them to "churn" between Medicaid and private insurance, potentially affecting 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.
"This is a complicated issue as all states are dealing with different health care landscapes and political realities," said lead author Heather Howard, a lecturer in public affairs at the Woodrow Wilson School. "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.
Both Howard and Shearer agree that there is no "one-size-fits-all" approach when it comes to the ACA. Likewise, they said it may take years to understand the outcomes of which plans are implemented and where.
"The ACA is a prime example of federalism, and we'll be studying state variation for years to come," said Howard. "The issue of churn and ensuring continuity of coverage and care for vulnerable populations is a fascinating lens through which to look at state innovation."
The paper, "State Efforts to Promote Continuity of Coverage and Care under the Affordable Care Act," was published by Duke University Press' Journal of Health Politics, Policy and Law.
To better inform the public about which options states are implementing, the journal is working toward building the Engaged State Health Reform Research Network, funded by Blue Shield of California and the Robert Wood Johnson Foundation. This group will bring together individuals from different backgrounds involved in state-level health reform implementation. A network website will eventually document progress, and the journal will publish open-access essays with findings.
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