Instability in Insurance Coverage: The Impacts of Churn in Rhode Island, 2014-2017

Churn, defined as a change in plan or a gap in insurance, is a problem in the United States that usually occurs as the result of changing life circumstances. Recent health reform perpetuates - rather than alleviates - churn because low- and middle- income individuals experience frequent changes in eligibility status. Our research asked: how common is churn in the non-group market and what are the health, financial, and emotional impacts on Rhode Island residents? This article draws examples from 31 life-history interviews and 188 enrollment observations conducted at Rhode Island's health insurance exchange from 2014-2017. The findings demonstrate that churn persists, despite state efforts to maximize enrollment, and causes poor health outcomes, financial insecurity, and increased stress. We argue that efforts to reform health insurance enrollment policies should be grounded in qualitative understandings of why people lose coverage and should seek to minimize barriers to maintaining continuous coverage.