Many state and federal officials implementing the Patient Protection and Affordable Care Act (ACA) are concerned about “churning,” the involuntary movement of consumers from one health plan or system of coverage to another. Churning makes programs more complicated and costly to administer and interrupts continuity of coverage and care.

Household circumstances change. As a result, churning is inevitable, since ACA preserves multiple insurance affordability programs and insurance markets. While state policy-makers cannot end such transitions, they can reduce their prevalence through a multipart strategy that addresses each component of churn. They can also limit the resulting damage by providing consumer assistance to help people navigate through health coverage transitions, by implementing policies that maintain continuity of care when consumers are forced to change health plans, and by taking steps to prevent eligibility transitions from creating coverage gaps and losses.

Earlier estimates of churning examined the effects of income fluctuations. This paper is the first that also takes into account affordable offers of employer-sponsored insurance (ESI), which disqualify consumers from all insurance affordability programs except Medicaid and the Children’s Health Insurance Program (CHIP).

About the Real Time Policy Analysis Quick Strike Series

The Urban Institute conducts research and releases reports for the Robert Wood Johnson Foundation on key issues related to health insurance coverage and the quality of health care in the United States. These issue briefs are designed to educate policy-makers considering reforms at the federal level to respond to the dynamic policy-making environment and inform the policy process. View a listing of all items in this series

About the Urban Institute

The nonpartisan Urban Institute gathers and analyzes data, conducts policy research, publishes studies and reports, and educates Americans on critical issues and trends to promote sound social policy and public debate on national priorities.