When the Affordable Care Act passed, observers were worried about health insurance “churn”: people moving from one health insurer to another at frequent intervals.

But early indications are that this churn, while real and a challenge, is not nearly as great as anticipated.

According to a 2015 survey of low-income adults in three states, churning is taking place less often than expected as people move from uninsured to privately insured to Medicaid-insured and then back again.

The leading causes of churn so far have been people obtaining insurance, changing jobs, losing Medicaid eligibility or marketplace subsidies, and inability to continue paying insurance premiums.

More than half of those who changed insurers reported gaps in coverage and care during their transitions.

The three states that were surveyed all responded to the Affordable Care Act’s passage differently:   Kentucky expanded its traditional Medicaid program, Arkansas enrolled new beneficiaries in private market plans, and Texas did not expand its Medicaid program at all.
Interestingly, there were no significant differences in churning rates between the states.

Churn is especially a challenge for low-income people, which especially makes it a challenge for private safety-net hospitals because they serve so many more low-income patients than most hospitals.

For a closer look at health insurance churn and what has happened since the Affordable Care Act’s passage, see the article “Insurance Churning Rates for Low-Income Adults Under Health Reform: Lower Than Expected” here, on the web site of the Commonwealth Fund.