Fewer People Maintain Obamacare Coverage Without Auto-Enrollment

Californians who lost the option to automatically re-enroll in an Affordable Care Act exchange plan were less likely to hold on to their insurance coverage than households that could enroll automatically, according to a study published Monday in JAMA Internal Medicine.

Researchers found that losing the option to automatically enroll in coverage was associated with a 30 percentage point drop in enrollment.

They concluded that the number of people insured through the ACA marketplace is likely to drop significantly if the CMS eliminates the option to automatically re-enroll.

There is speculation that the CMS is mulling such a move. The agency in January asked for comment on the automatic re-enrollment process and potential policies to reduce government misspending associated with it for future rulemaking.

The findings also have implications for the handful of states shifting to a state-run exchange instead of relying on the federally operated HealthCare.gov. Most recently, Maine said it is exploring running its own exchange in 2021, following recent moves by Nevada, New Jersey, New Mexico and Pennsylvania.

“Being able to manage the automatic re-enrollment transition to a state-based exchange will be a significant operational challenge, and if they don’t manage it well, there’s going to be a big drop in enrollment,” said David Anderson, a research associate at Duke University’s Margolis Center for Health Policy and co-author of the study.

Since the beginning of the ACA exchanges, current members have had the option to either actively select a health plan or do nothing and be automatically re-enrolled in their current plan. During open enrollment for 2019, 3.4 million, or 30%, of the 11.4 million marketplace enrollees were automatically signed up for a plan based on their 2018 coverage, according to the CMS.

California households enrolled in coverage through the state’s exchange, Covered California, as of Dec. 31 in a given year during the 2104 to 2017 study period were able to automatically re-enroll in coverage unless their health insurer exited the marketplace.

UnitedHealthcare, for example, stopped selling exchange plans in several California counties in 2017 after losing money. Another insurer, Contra Costa Health Services, exited Contra Costa County, Calif., in 2015.

Researchers analyzed individual enrollment data and found that the re-enrollment rate was 51.2% among 122,463 households in areas and years that experienced an insurer exit but still had the option to automatically re-enroll. The adjusted rate was much lower at about 21.5% among the 781 households that could not automatically re-enroll.

The study authors said more research is needed given the small sample size of the group that lost the ability to auto-enroll. Moreover, they said losing automatic enrollment because of policy changes instead of an insurer exit may lead to different results.


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