January 20, 2017

GOP reportedly considers plan to automatically sign Americans up for insurance

Daily Briefing

    Republican lawmakers are mulling whether to include an automatic-enrollment provision in a replacement plan for the Affordable Care Act (ACA) if the law is repealed, Greg Ruben reports for Axios.

    Automatic enrollment

    According to Ruben, some GOP lawmakers and conservative health policy analysts have been discussing an automatic-enrollment provision as a way to replace the ACA's individual mandate while still covering individuals with pre-existing conditions.  

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    Under an automatic-enrollment provision, U.S. residents who do not obtain coverage on their own—either through their employers or elsewhere—would automatically be enrolled in a basic health plan. According to Ruben, the federal government would cover the cost of premiums for such plans. Individuals would have the choice to opt out of the basic health plans, as well as to purchase different coverage with additional benefits.

    The policy could help to balance the individual health insurance market, conservative stakeholders say, but it would not necessarily save the government money. Joe Antos, a conservative health economist, said, "It's a way of stabilizing the individual market. But if it's also going to be used as a way to save billions of dollars, then it's not going to save the individual market."

    Several proposals to replace the ACA have included an automatic-enrollment feature, Ruben reports, including separate plans introduced by Sen. Bill Cassidy (R-La.) and Rep. Pete Sessions (R-Tx.), as well as a white paper by the American Enterprise Institute. President-elect Donald Trump's nominee for HHS secretary Rep. Tom Price (R-Ga.) also included an automatic-enrollment feature for employer-sponsored coverage in an ACA replacement plan he previously proposed, which is a "sign the idea could gain traction," Ruben writes.

    Automatic-enrollment faces political, logistical challenges, stakeholders say

    But both liberal and conservative health policy analysts say an automatic-enrollment provision faces certain challenges, Ruben reports. 

    For example, the government would have to determine which U.S. residents should be automatically enrolled in coverage. In addition, consumers who are automatically placed in basic health plans could face extra out-of-pocket costs if they need to access services that are not covered by the plan.

    Further, Antos said policymakers could face difficulties persuading private insurers to offer basic health plans. "You'd have to find a way to make sure, if there's more than one insurer, that the actual expenses of covering these upper-end costs for people pretty much balances out with a reasonable profit margin," Antos said.

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    Moreover, while some Republicans have expressed support for an automatic-enrollment feature, they might have a hard time convincing other conservatives that the policy "is less intrusive than an insurance mandate," Ruben writes.

    Also, some experts believe keeping the ACA's individual mandate would be more effective than implementing an automatic-enrollment provision. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who helped draft the ACA, said, "I think more people would opt out of enrollment than would take a fine with the individual mandate" (Owens, Axios, 1/19).

    5 must-have upgrades for the consumer-focused health system (with or without the ACA)

    5 must-have upgrades for the consumer-focused health system

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