Modifications to current policies could help ensure that health insurance coverage and subsidies provided under the Affordable Care Act remain stable even through major life changes, according to a new Commonwealth Fund report released May 19. At least 34 million people will gain new coverage under the law, and the report's authors say that it will be important to ensure that life changes like fluctuations in income and job transitions don't cause abrupt changes in people's health insurance coverage or financial responsibilities for their premiums or care. Uncertainty about how life changes could affect their health insurance and premium costs might lead people to delay signing up for coverage through the exchanges and Medicaid, and could cause people who have received premium subsidies to have to pay money back if their incomes are higher than expected.
"The Affordable Care Act will ensure universal access to affordable coverage and provide a single point of entry for people to qualify for help in paying for health insurance," said lead author Pamela Farley Short, a professor at Penn State University's Department of Health Policy and Administration. "To minimize gaps and churning in health insurance, however, it will be critical that federal and state policymakers implementing the law make sure that it is simple for people to sign up for, pay for, and keep their coverage when their lives change. This will also help reduce administrative costs to federal and state governments."
According to the report, Realizing Health Reform's Potential: Maintaining Coverage, Affordability, and Shared Responsibility When Income and Employment Change, people could experience coverage gaps or changes in financial responsibility for a number of reasons:
In order to reduce the potential for gaps and churning in coverage, the authors recommend a series of policy steps that state and federal policymakers could consider to smooth the process for families and help limit administrative burdens. For example:
"The promise of The Affordable Care Act is that, for the first time ever, all Americans will have access to affordable, comprehensive health insurance, with far more information about their benefits and out-of-pocket costs," said Commonwealth Fund President Karen Davis. "However, in order to reach health reform's full potential, policymakers must take care to implement the law in a way that will take the guesswork and uncertainty out of people's health insurance decisions."
The report, co-authored by Katherine Swartz from Harvard University and Namrata Uberoi and Deborah Graefe from Penn State, is available at http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2011/May/Maintaining-Coverage.aspx.
The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.
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