For millions of low-income Americans, the road to health care reform in 2014 could prove to be a jagged line through which they bounce between public exchanges and Medicaid as their income fluctuates over the year.

While the effect on care consistency, quality and cost generates concern for those forced to switch health plans or doctors, it may pale in comparison to the “churning” phenomenon long seen in Medicaid when program eligibility is lost and then regained.

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