Conservative groups to Senate Republicans: No auto-enrollment in ACA repeal

Conservative advocacy groups laid out their priorities for healthcare policy as the Senate crafts its own version of an Affordable Care Act (ACA) replacement, warning against a proposed “auto-enrollment” option to replace the ACA’s penalty for not buying insurance.

In a May 22 letter to Senate Majority Leader Mitch McConnell, R-Kentucky, conservative groups Freedom Partners and Americans for Prosperity (AFP) said the goal of the American Health Care Act (AHCA) should be to “repeal as much of Obamacare as possible.” To that end, the groups asked for halt on the ACA’s expansion of Medicaid, the law’s mandates for coverage for people with pre-existing conditions and the tax subsidies offered under the ACA for buying insurance.

They also criticized the concept of people being automatically enrolled in an catastrophic insurance plan, an idea which has appeared to gain traction among some Republicans to replace the ACA’s individual mandate.

“Furthermore, the Senate should avoid creating new regulatory burdens for individuals and families, such as allowing Washington to automatically enroll people into taxpayer-subsidized insurance plans,” the Freedom Partners and AFP letter said. “Enrolling people without their consent is a giveaway to insurers that inflates prices, drives up costs for taxpayers, and keeps Washington at the center of health care.”

The idea was included in an earlier ACA replacement plan from Sens. Bill Cassidy, MD, R-Lousiana, and Susan Collins, R-Maine. Anyone would didn’t have coverage through an employer or individual market would be automatically enrolled in a high-deductible health plan with pharmaceutical benefits that means network adequacy requirements set by HHS. People would be allowed to opt out of the requirement, but Cassidy said insurers the idea would lower premiums by 20 percent “while keeping people who are sicker” in the risk pool.

The concept has reportedly been discussed in private meetings on healthcare between Senate Republicans. It also has some support among ACA supporters, with former CMS Acting Administrator Andy Slavitt telling Vox “it’s a viable idea.”

The resistance from conservative groups to such an idea highlights the divisions between the conservative House legislation and the more moderate Senate, where Republicans can only afford to lose two votes among its caucus.