Insurance churning can affect quality, cost, and continuity of care.2 Individuals may avoid seeking health care when they need it during gaps in insurance coverage. Even if consumers maintain continuous coverage while transitioning between different insurance plans, they may find that their regular health care providers do not accept their new insurance plan. In addition, when they change health plans, research shows that medication compliance is often disrupted.2 ibid These and other churning-related problems tend to be exacerbated by uncertainty about what new co-pays or deductibles might be as well as by known increased costs associated with new insurance plans.
A recent study found no evidence of significant increases or decreases in broader indicators of insurance churning since the introduction of the ACA in three states (Texas, Kentucky, and Arkansas).2 ibid Under the new administration, depending on which provisions of the ACA are repealed, replaced, de-funded, or retained in the coming years and how these changes are implemented, rates of insurance churning could change dramatically. Uncertainty and changes in availability of coverage and out-of- pocket costs could contribute to greater churning during the implementation of new health care policies.3
Between 2013 and 2015, data from the Census Bureau show that the proportion of Michiganders who reported no source of health insurance declined by five percentage points—from 11 percent to 6 percent.4 Using data from the Center for Healthcare Research & Transformation’s Cover Michigan Survey, this brief explores consumer experiences with insurance churning and access to care within the state of Michigan for approximately a one-year period in 2014–2015.
- Medicaid recipients had the most instability in their coverage status of all respondents to the survey. Medicaid recipients were also seven times more likely to have experienced a temporary uninsured period in the past year compared to respondents with employer-sponsored or individual coverage.
- Those with individually purchased coverage in 2014 were the most likely to switch to a different type of coverage in 2015. Among respondents with an individually purchased plan in 2014, less than half re-enrolled in the same plan in 2015, and nearly a third
transitioned to Medicare or to an employer-sponsored plan in 2015.
- Those with employer-sponsored coverage experienced the least amount of churning compared to respondents with other coverage. Ninety-four percent of respondents with employer-sponsored coverage remained continuously insured from 2014 to 2015.
Twenty-two percent of respondents with Medicaid experienced a temporary period of being uninsured, compared to only 4 percent of respondents with employer-sponsored and individually purchased coverage. Eight percent of respondents with Medicaid in 2014 were uninsured by the time they were surveyed in 2015—a higher proportion than the overall state average of 5 percent.5 Figure 1
Sixty-two percent were continuously enrolled in Medicaid for the entire year and 22 percent gained insurance coverage after temporarily being uninsured; of these, 19 percent re-enrolled in Medicaid and 3 percent secured employer-sponsored coverage. By comparison, 84 percent of Americans with Medicaid maintained continuous coverage all year.6
Only 48 percent of respondents who had individual coverage in 2014 re-enrolled in the same plan in 2015 (1 percent after an uninsured period). Eleven percent switched directly from one individual plan to another, while an additional 1 percent made this switch after a temporary uninsured period.
Seventy-two percent of Michigan respondents were continuously covered by the same employer-sponsored plan, 16 percent directly switched to a different employer-sponsored plan and 6 percent gained coverage through either an individually purchased plan,
Medicaid, or Medicare.
Just 4 percent reported being temporarily uninsured during the previous 12 months. Among this group, less than 1 percent re-enrolled in the employer-sponsored plan they had previously, while 3 percent enrolled in a different employer plan by the time of the survey in 2015.
The highest rates of insurance churning—47 percent—were reported by the youngest group of respondents (18–24 year olds). Churning decreased significantly as age increased, with just 18 percent of those 55 and older having experienced churning. Figure 4
Less than half of those with an individually purchased insurance plan in 2014 re-enrolled in the same plan in 2015. Many of these respondents may have purchased insurance for the first time during the first post-ACA open enrollment period in 2014 and then decided to switch to a different insurance plan in 2015. Some of the churning in this group may also be attributable to changes in eligibility for other types of insurance. Nearly a third of those with an individually purchased insurance plan in 2014 transitioned to Medicare or to an employer-sponsored plan in 2015.
Respondents with Medicaid in 2014 were less likely to switch plans, but more likely to be uninsured in 2015, or to report temporarily being without coverage in the previous 12 months. In contrast, respondents with an employer-sponsored health plan in 2014 were the least likely to become or remain uninsured.
These findings suggest Michigan consumers may experience different types of insurance churning depending on their type of coverage. Whether due to switching to a different plan or experiencing a temporary period of being uninsured, such disruptions in coverage may have implications for consumers being able to access health care and preferred health care providers. These findings show continuing opportunities for Michigan insurance companies to reach out to the uninsured and develop strategies to help reduce uninsured periods.
For analytical purposes, survey data were weighted to adjust for the unequal probabilities of selection for each stratum of the survey sample (for example, region of the state, listed vs. unlisted telephones). Additionally, data were weighted to adjust for non-response based on age, gender, and race, according to population distributions from the 2009–2013 American Community Survey data. Respondents who reported both Medicare and Medicaid coverage were considered Medicaid recipients for the purpose of this analysis. Because the survey did not distinguish between the different types of Medicare plans available to consumers (i.e., “original” Medicare, Medicare Advantage plans and Medicare Part D), we were not able to develop meaningful analyses of churning for this population, therefore respondents who reported that Medicare was their only form of coverage were excluded from this analysis. Results were analyzed using SPSS 24 software. Statistical significance of bivariate relationships was tested using z tests or chi-square tests for independence. All comparisons are statistically significant at p < 0.05 unless otherwise noted. A full report of the IPPSR State of the State Survey methodology can be found at: http://ippsr.msu.edu/soss/.