Maximizing Health Care Enrollment Through Seamless Coverage for Families in Transition: Current Trends and Policy Implications

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The Affordable Care Act (ACA) builds on the employment-based health insurance system which is the bedrock of health insurance coverage for most Americans. When these Americans experience a change in their work or family lives, they are at risk for losing their job-based health insurance coverage. The health insurance exchanges established by the ACA provide an unprecedented opportunity to address one of the major sources of gaps in health insurance coverage: transitions in life that result in the loss of health insurance. The uninsured population is not static. Many people who are uninsured cycle in and out of coverage over a short period of time. One-half to two-thirds of those who are uninsured in any given year move into or out of coverage in that year. Even short bouts of uninsurance can have important health impacts due to lack of care.Many who are intermittently uninsured are experiencing a work or life transition that also involves a loss of income, divorce or separation, loss of dependent status, disability or death of a family member.These individuals in transition are likely to make up a significant portion of those eligible for the new health insurance exchanges. In Massachusetts, approximately one-quarter of individual market participants in the Massachusetts “Health Connector” the state’s health exchange, enrolled and terminated their coverage within 12 months. How transitional coverage is handled will play a major role in whether the ACA is successful in expanding and stabilizing health coverage. In order to be successful in enrolling the uninsured, the exchange should be designed to maintain continuous coverage for individuals undergoing life transitions. Understanding the triggers to uninsurance provides an important window into how people who are in life transitions can be reached and enrolled into the exchange before or when they lose other sources of coverage.

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University of California, Berkeley Center for Labor Research and Education Center on Health, Economic & Family Security