If health insurance exchanges survive the legal challenge to the Patient Protection and Affordable Care Act, providers can expect challenges as the working poor frequently shift between Medicaid and subsidized health plans, Jennifer Kent, a principal with Health Management Associates, told attendees at an early morning session at the Healthcare Financial Management Association's yearly meeting.
Exchanges could lead to churn: HMA exec
The U.S. Supreme Court is expected to release its decision this week to a legal challenge that could invalidate some or all of the reform law, which includes health insurance exchanges where individuals and small businesses can purchase subsidized health plans.
Kent, who oversaw the development of California’s insurance exchange in her former role as deputy legislative secretary for the state’s office of the governor, said an estimated 29.4 million people would churn between the safety net insurer and subsidized exchange health plans as household income fluctuates with shifting work schedules.
That could disrupt the continuity of patient care as patients lose and regain commercial insurance coverage, depending on which insurers are under contract with patients’ providers, she said.
Providers can also expect insurers that face rate reviews to be far more sensitive to the relative cost and quality of providers under contract, Kent told the crowd on the last day of the HFMA’s Annual National Institute in Las Vegas. Insurers will question contracts with providers with higher costs but no better quality than competitors, she said.
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