The primary goal of the Affordable Care Act—getting the uninsured and working poor access to health insurance—is likely to be complicated by the fact that the regular complications of life (marriage, divorce, having children, job changes, layoffs) have such a significant impact on the income of people living on the edge of poverty. Those life changes could result in interruptions not just in health insurance coverage, but in
health care for these people, as they ping-pong between being eligible for subsidies versus Medicaid.
As their family incomes change, so too will their eligibility for public insurance programs. And if nothing is done, policymakers warn, many low-income patients will lose access to their doctors and medications during this massive game of health coverage pingpong.
Policymakers and healthcare industry leaders across the nation are paying close attention to the issue and working to close the coverage gaps before Jan. 1, said Alan Weil, executive director of the National Academy for State Health Policy. [...]
Nationwide, income fluctuations are estimated to interrupt coverage for as many as 28 million people expected to bounce between Medicaid and the federally subsidized health insurance exchanges that states are working to create, according to an article in the journal Health Affairs. Among those most at risk are seasonal and hourly workers and young adults who lack coverage through their parents or jobs, experts said.
Of course, the good news with Obamacare is that this group of people will at least have access to health insurance, either on the exchange or through Medicaid (if they live in a state that's implementing the Medicaid expansion), something that wouldn't have happened for most before the law. They would just be uninsured.
It's good that this is an issue policymakers are aware of and that they're trying to figure out. But the potentially larger issue that still seems to be hanging out there with no solution is what happens to all the people falling into the gap created by states that aren't expanding Medicaid. That's a problem that so far has no solution.