Auto-enrollment being discussed as part of Trump healthcare plans

While the individual mandate would be eliminated under the current plans to repeal the Affordable Care Act (ACA), a separate idea to keep more people in the risk pool has emerged: auto-enrollment in a “bare-bones” health plan.

Caitlin Owens of Axios reports health policy experts and staff members advising Republican members of Congress are looking at auto-enrollment as a way to maintain the costlier protections for pre-existing conditions. President-elect Donald Trump has said he wants that provision retained, but with healthier people allowed to leave the risk pool without penalty, premiums could skyrocket and the individual market could enter a death spiral.

It would work like this: People without access to insurance from another source would be automatically entered in a plan with “skimpy” coverage and likely a very high deductible, somewhere around $10,000. People would be allowed to opt out without paying a fine, unlike the individual mandate.

But the approach comes with plenty of obstacles, like how to get private insurers to participate.

“You'd have to find a way to make sure, if there's more than one insurer, that the actual expenses of covering these upper-end costs for people pretty much balances out with a reasonable profit margin," said Joe Antos, health economist with the conservative American Enterprise Institute.

There would be other challenges, such as making sure Medicare and Medicaid beneficiaries aren’t signed up, but it may be a solution to concerns about destabilizing the individual market.

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