People lose coverage when their life changes (churn)

Coverage changes with jobs, income, age, marriage, and moves. Each switch can mean new networks, new deductibles, interrupted treatment, and paperwork. Medicaid redeterminations removed about 25 million people in 2023–24, many for paperwork reasons.

Evidence

Medicaid enrollment fell from 92.2M to 84.3M in 2024 as eligibility checks resumed.
Sources: CMS Office of the Actuary (2025)

Who's affected

Who is hurt

People whose job, income, or home changes: They lose coverage when income, job, or address changes.
People with ongoing or specialist care needs: Treatment is interrupted when coverage lapses mid-course.

Who gains while it lasts

Health insurers, brokers, and their shareholders: Insurers avoid the long-term costs of members who leave.
Taxpayers and public budgets: Budgets save money when eligible people fall off.

Under your mix of paths

Paths that fix or soften it

Using your saved plan. 0 paths picked.Edit all picks

Root causes

Means-tested programs need repeated income checks
Employer coverage ends with the job
Separate programs by age and income

Related costs

Open questions

Should eligibility ever be re-checked once someone is covered?
Should coverage continue automatically between jobs?

Solution paths (2)

Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.

Continuous eligibility (12-month or multi-year) in Medicaid and CHIPChosen

Once enrolled, people keep coverage for at least 12 months (or until age 6 for children) regardless of income changes.

+People lose coverage when their life changes (churn)
+About $1 trillion a year in administrative cost

−Directs benefits or burdens imperfectly

Coverage tied to residence, not job or incomeChosen

Under single payer or a regulated multi-payer system, coverage never depends on employment or income, so life changes do not end coverage.

+People lose coverage when their life changes (churn)
+About $1 trillion a year in administrative cost

−Depends on other changes to work
−Adds paperwork, coordination, or complexity

Also addressed by paths for other problems

Single public payer for everyoneTens of millions of people have no coverageChosen

Coverage no longer ends when income, job, family, or state changes.

Regulated multi-payer: everyone must have a non-profit or tightly regulated planTens of millions of people have no coverageRejected

Mandatory enrollment in plans that accept all applicants provides a continuing route to standard coverage.