Mind the Gap: Basic Health Along the ACA's Coverage Continuum

Abstract

As ACA implementation proceeds, expansion states should mind the gap — the gap between Medicaid and Marketplace. In this transition between insurance platforms, people can stumble. As a bridge between expanded Medicaid and the insurance Marketplaces, the ACA allows states to enact a Basic Health Program (BHP) supported by federal funds. The BHP option, which has been delayed until 2015, aims to reduce insurance costs and increase care continuity for low-income individuals and families.

Interested states face a complicated calculus, one with significant unknowns and moving parts. In this article, I first place this new insurance affordability program in the context of comprehensive health reform efforts. I then explain key issues in a state’s BHP decision-making, and go on to consider related, evolving coverage options. Ultimately, whether a state adopts the BHP or not, it ought to mind the gap between Medicaid and Marketplace. In this transition between insurance platforms, central ACA goals of affordability and continuity will be tested.

Keywords: ACA, Affordable Care Act, Health Reform, Basic Health Option, Medicaid, Exchanges, Marketplace, Health Insurance