According to a study released this week in Health Affairs approximately 28 million Americans will fluctuate between being eligible for Medicaid and eligible for an insurance premium subsidy in the ObamaCare exchanges. This switching back and forth between types of coverage is referred to as “churning”, and it will have a drastic effect on the individuals and families in this category. Being on Medicaid is very different from private insurance. For example, access to physicians in Medicaid is restricted to those who accept Medicaid. In Texas this is only about 1/3 of the physicians, and therefore, Medicaid provides much less access to care than someone in the private market. For a young, single adult going from one primary care physician to another is a rather uneventful occurrence. But, it is not an unlikely situation that a family with a developed relationship with their pediatrician would fall into Medicaid eligibility and lose access to their family’s doctor. Even once would be disruptive for a family, but to potentially go back and forth multiple times a year would be detrimental.
Creating a separate level of health care for any specific group of people, rich or poor, disrupts health care. That is why in the Foundation’s proposal released this week, the TexHealth model does not restrict the types of insurance plans for this population. So the plan a family has when they receive a subsidy is the same plan as with no subsidy. The only difference is how much they pay.