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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Automatic for the People

The crucial nature of the individual mandate for health care reform has drawn some helpful attention to the fact that universal coverage isn’t just a charity measure for the uninsured, but a way of creating a risk pool broad enough to lower costs generally, while also avoiding over-utilization of high-cost care options like emergency rooms. In fact, private insurance companies are among the most avid supporters of the individual mandate because it guarantees them new customers.
But as Peter Harbage explains at The New Republic today, a penalty-based coverage mandate isn’t the only way, or even the best way, to get more people insured:

[F]or all of the attention we’re paying to mandates, we’re not giving nearly enough attention to automatic enrollment and other innovations that can get people insured, rather than penalize them if they’re not. Ideally, we’ll get to a “culture of coverage” where everyone assumes they are supposed to have health insurance, much as everybody now assumes they are supposed to get primary education. The situation is quite similar, actually: We have truancy penalties, but most parents send their kids to school because the education system is affordable to families, easy to access, and social pressure says it is the right thing to do.

Automatic enrollment could not only make sure people are insured, but can also help steer them to the plan best designed for their medical and economic circumstances. They would be free to change coverage, but wouldn’t be forced to navigate the current highly complex system to get covered in the first place. It’s worth thinking about as we near the end-game of the health reform debate.

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