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With Health Care Reform, Income Swings May Mean Loss of Coverage
Date:2/3/2011

By Amanda Gardner
HealthDay Reporter

THURSDAY, Feb. 3 (HealthDay News) -- Under the new Affordable Care Act, the health reform package signed into law by President Barack Obama last March, millions of Americans whose income fluctuates during the year may lose health insurance for periods of time as their eligibility for different programs changes.

The authors of a new study appearing in the February issue of Health Affairs estimated that as many as 28 million U.S. adults might "churn" in and out of health insurance programs during the course of a year, sometimes losing coverage more than once.

"It's a critical issue," said Cathy Schoen, senior vice president of The Commonwealth Fund, who was not involved with the study. "You could get a raise or lose a week of work or gain a week, and move in and out of coverage."

The problem is a version of the "churning" in and out of Medicaid that has occurred for years, but with some improvements.

Under the traditional Medicaid system, people shifted between having coverage or not having coverage depending on how much they were making.

Under the Affordable Care Act, Americans can move between two programs: Medicaid, which will now be offered to all those whose income does not exceed 133 percent of the poverty line (about $13,800 per year), and premium subsidies in state-run insurance exchanges, which will be available to people above that dividing line up to 400 percent of the federal poverty level (about $41,500).

But when their eligibility fluctuates, they're likely to lose coverage at least for a period of time.

"The good news with the Affordable Care Act is that, rather than falling off of public coverage into nothing, which is what happens now, there's the potential to have you picked up right away by the exchanges," Schoen said. "But unless you coordinate the plans that are being offered and the networks being offered, you could still hav
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