Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges
Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges
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DOI：
10.1377/hlthaff.2010.1000
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发表时间：
2011-02-01
期刊：
影响因子：
9.7
通讯作者：
Rosenbaum, Sara
中科院分区：
文献类型：
--
作者：
Sommers, Benjamin D.;Rosenbaum, Sara
《平价医疗法案》将通过扩大医疗补助资格和通过州医疗保险交易所为购买私人医疗保险提供保费补贴来扩大医疗保险覆盖范围。但根据定义，这些计划的资格对收入很敏感，并且会随着收入的波动和家庭组成的变化而变化。法律没有规定最低入学期限，补贴水平也会随着收入的上升和福尔斯而变化。使用全国调查数据，我们估计，在六个月内，家庭收入低于联邦贫困线200%的所有成年人中，超过35%的人将经历从医疗补助到保险交易所的资格转变，或者相反;在一年内，50%，即2800万，将。为了最大限度地减少对护理连续性和质量的影响，各州和联邦政府应采取战略，减少覆盖过渡的频率，并减轻这些过渡造成的中断。选择包括建立一个最低保证资格期和“双重认证”一些计划，以服务于医疗补助和交换登记。
The Affordable Care Act will extend health insurance coverage by both expanding Medicaid eligibility and offering premium subsidies for the purchase of private health insurance through state health insurance exchanges. But by definition, eligibility for these programs is sensitive to income and can change over time with fluctuating income and changes in family composition. The law specifies no minimum enrollment period, and subsidy levels will also change as income rises and falls. Using national survey data, we estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level will experience a shift in eligibility from Medicaid to an insurance exchange, or the reverse; within a year, 50 percent, or 28 million, will. To minimize the effect on continuity and quality of care, states and the federal government should adopt strategies to reduce the frequency of coverage transitions and to mitigate the disruptions caused by those transitions. Options include establishing a minimum guaranteed eligibility period and "dually certifying" some plans to serve both Medicaid and exchange enrollees.