In a concept in behavorial science, policymakers identify incentives for people to make decisions that are better for them and for society. The key to the approach, called "nudging," is motivating people to make a particular choice without making them feel a decision was forced on them.
Nestled within a centrist Republican proposal to replace Obamacare is a concept called auto-enrollment that aims to use the nudging principle, and proponents believe it would reduce the number of uninsured while gutting the unpopular individual mandate requiring people to obtain insurance or pay a penalty.
Auto-enrollment was part of the conversation when Obamacare's individual mandate was challenged in the Supreme Court and has appeared in various Republican proposals since the law's passage, including one bill House Speaker Paul Ryan, R-Wis., introduced in 2009. Now, it is being raised again by centrist Republicans in legislation authored by Sens. Bill Cassidy of Louisiana and Susan Collins of Maine.
Through their bill, the Patient Freedom Act, states would decide not only whether they want to keep Obamacare but also whether they want to craft their own proposals, which could include an auto-enrollment provision. Residents would be provided with a federally funded, age-adjusted tax credit that would go into a health savings account so that they could buy a private insurance plan. Households that don't use the credit would be enrolled automatically in a basic, or catastrophic, plan with the amount of the credit going to insurers to pay for premiums.
"It wouldn't preclude people from taking more generous coverage, but it can discourage them from opting out because they would be throwing away the tax credit," said Mark Pauly, professor of healthcare management at the Wharton School of Business at the University of Pennsylvania. "It's a fairly clever idea to make people do what they ought to without feeling too persecuted with it."
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01.16.2025