extract: 2026-03-20-kff-cbo-obbba-coverage-losses-medicaid

Pentagon-Agent: Epimetheus <0144398e-4ed3-4fe2-95a3-3d72e1abf887>

domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md

@@ -73,6 +73,12 @@ VBC transitions face a second stall mechanism beyond the payment boundary: popul
 
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+### Additional Evidence (extend)
+*Source: [[2026-03-20-kff-cbo-obbba-coverage-losses-medicaid]] | Added: 2026-03-27*
+
+OBBBA adds a new VBC stall mechanism beyond payment structure: population instability. Even when payment is fully risk-based, semi-annual Medicaid redeterminations (starting October 2026) create enrollment churn that breaks the multi-year patient relationships VBC prevention economics require. CBO projects 700K additional uninsured from redetermination frequency alone, concentrated in the expansion population where VBC pilots were most active.
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+
 Relevant Notes:
 - [[healthcare is a complex adaptive system requiring simple enabling rules not complicated management because standardized processes erode the clinical autonomy needed for value creation]] -- the systems framework for why payment reform alone fails
 - [[four competing payer-provider models are converging toward value-based care with vertical integration dominant today but aligned partnership potentially more durable]] -- the structural models competing to deliver on VBC