One of the difficulties people often have with the American health care system is that it's been sliced up into a variety of mostly distinct subsystems: Medicare, Medicaid, employer sponsored insurance, the individual market. Rather than a single, continuous landmass that allows for easy movement from one point to another, it's more like a series of awkwardly linked islands. As a result, it can be frustrating for individuals whose circumstances (income shifts, job loss, etc.) require them to hop between those islands.
Did the authors of last year's health care overhaul make a substantial effort to address the system's lack of continuity? Not really. Instead, they came up with a way to retrofit the old employer-sponsored system—and built in additional transition points that could prove tough to navigate. As California Healthline notes, new research suggests that ObamaCare will actually exacerbate the problem of "churn" within the system, especially at low income levels:
Health care officials who work with large Medi-Cal populations say fluctuations in eligibility cause quality of care to decline and the cost of care to increase because of added administrative expenses. Medi-Cal beneficiaries moving in and out of coverage—known as "churning"—is not a new phenomenon, but it may become more prevalent under health care reform.
The Affordable Care Act's two primary weapons aimed at reducing the number of uninsured—expanded Medicaid eligibility and subsidies for buying private coverage through state health insurance exchanges—could produce considerable churning if they're not carefully implemented.
According to a study published last month in Health Affairs, income fluctuations in the first year of expanded coverage under the new law could produce eligibility shifts for as many as 28 million people who will become newly eligible for subsidized health insurance. According to researchers' predictions, after four years of expanded coverage under ACA, 19% of adults initially eligible for Medicaid will have been continuously eligible. About 31% of adults eligible for insurance subsidies will have remained continuously eligible, researchers predict.
The basic takeaway from all this is that states are going to have to come up with patches to try to reduce the amount of system churn and smooth out the health care experience for those whose income bounces them between systems. In other words, it's more of what we've come to expect from ObamaCare: More bureaucratic busywork for states, and more hassles for those trying to get care.