Many officials implementing the ACA are concerned about “churning,” the involuntary movement of consumers from one health plan or coverage system to another. Churning makes programs more costly to administer and interrupts continuity of coverage and care. Unless measures are taken to reduce churning, 27 million nonelderly people will be forced to change coverage systems from year to year, two-thirds of whom will move between Medicaid and ineligibility for all subsidies. We estimate the impact of several steps states can take to reduce churning and mitigate its adverse effects. This is the first churning study to consider employer coverage offers.