Eliminating Automatic Insurance Reenrollment Can Increase Number of Uninsured

MedicalResearch.com Interview with:

Dr. Drak

Coleman Drake, PhD
Assistant Professor, Department of Health Policy and Management
Affiliate faculty member
Center for Pharmaceutical Policy and Prescribing
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: Every year, the Centers for Medicare and Medicaid Services puts out of notice of proposed changes to the rules governing the Health Insurance Marketplaces created by the Affordable Care Act (e.g., healthcare.gov). The most recent notice for 2020 (issued in 2019) considered eliminating automatic reenrollment for Marketplace enrollees.

On the one hand, requiring that enrollees actively select a health plan to stay insured is a good thing because it forces them to consider their options – we know that people make better health plan choices when they consider their choices.

On the other hand, creating an administrative barrier to staying insured could cause some people to become uninsured. Since 3.4 million Marketplace enrollees used automatic enrollment in 2019, eliminating it might cause a spike in the uninsured rate.

MedicalResearch.com: What should readers take away from your report?

Response: We examined two cases where insurers exited California’s Marketplace in 2015 and 2017, which left their former enrollees without the option to automatically reenroll. We found that the probability that enrollees returned to the Marketplace upon losing automatic reenrollment dropped by 30 percentage points.

This indicates that having the option to automatically reenroll in one’s health coverage is a powerful tool to keep people insured and not have lapses in health coverage and perhaps health care.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The Centers for Medicare and Medicaid Services should not eliminate automatic reenrollment. While it would improve enrollees’ plan selections, the costs in terms of the increase in the number of uninsured would be quite high. If automatic reenrollment is eliminated, states operating their own Marketplaces like California should create their own automatic reenrollment programs. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The House of Representatives subpoenaed analyses from the Centers for Medicare and Medicaid Services that found results similar to our own, suggesting our results may be generalizable beyond California.


Drake C, Anderson DM. Association Between Having an Automatic Reenrollment Option and Reenrollment in the Health Insurance Marketplaces. JAMA Intern Med. Published online September 23, 2019. doi:10.1001/jamainternmed.2019.3717 


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Last Updated on September 23, 2019 by Marie Benz MD FAAD