Health Affairs January 16, 2020
The Affordable Care Act’s (ACA) individual shared responsibility penalty was reduced to $0 in 2017, effectively repealing the individual mandate and removing a key means of reducing uninsurance. For those who want to reduce uninsurance, auto-enrollment may be a feasible alternative. Overcoming some of the administrative challenges of previous proposals, Brookings Fellow Christen Linke Young’s retroactive model offers new hope for auto-enrollment into health insurance. However, Young’s approach risks exacerbating certain behavioral biases with perverse outcomes for enrollees.
Auto-enrollment is a kind of “nudge,” building on the behavioral bias toward inertia. But the very bias that makes auto-enrollment powerful also presents challenges for policy makers. People who are auto-enrolled may underuse their entitlement and may remain enrolled in an...
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