Here's a look at some of the specific reasons states ought to consider adding a basic health program to their list of options for low-income populations:
- A BHP could specifically address the medical needs of the low-income population.
The low income population often has special coverage needs. A BHP could be set up to make sure the right providers, services, and benefits, such as transportation and mental health benefits are available.
- A health insurance exchange would be disruptive to a vulnerable population.
The beneficiary mix will probably be more diverse for exchanges so there could be a broad membership with different needs and ailments. The low-income population has needs that extend beyond insurance and can be difficult to meet. Shifting the low-income population from Medicaid straight into an exchange would be a major move that could involve a different plan, different providers and increased healthcare costs. Even with an income of 200% of FPL the population could struggle to meet the new costs; making the shift to an exchange with an income of 133% of FPL would be even difficult.
- A BHP could reduce churning.
According to a Health Affairs article, How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges, more than 50% of all adults with family incomes below 200% of the FPL will experience a shift in eligibility from Medicaid to an insurance exchange, or the reverse; within one year. That's called churning. It creates administrative headaches for states, coverage lapses for families, and increases the likelihood that hospitals and physicians will not be reimbursed for their services.
- A BHP could stabilize coverage.
A BHP could be set up so enrollees can remain with the same health plan if their income increases above 133% of FPL and they move from Medicaid to the BHP. That would make it easier for this population to remain with familiar providers and maintain their familiar coverage. It would also help reduce the administrative costs incurred by providers for processing insurance changes.
- A BHP could reduce the number of uninsured.
A state will receive a lump sum payment to cover healthcare for the low-income populations. If the lump sum is more money than the state needs, the excess funds can be used to reduce some of the out-of-pocket costs, like copayments, for this group. Making care affordable for this population will make it more likely that health insurance will be maintained.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.