Last week, Tim Jost raised a very interesting point in comments regarding auto-enrollment. I’ve been wrestling with it for a bit and I’m still trying to organize my thoughts:
I would add yet another group that I am not sure is captured in the four categories listed–people who just don’t want health insurance. They rarely need health care and when they do go to the local community health center or free clinic or work out some arrangement with a local doctor or local hospital. They would be quite upset if they found out that someone had enrolled them in coverage even if they could opt out of it There are a lot of people here in rural Virginia whom I think would fit in this category..
I’m still trying to figure out how meaningful this group would be if we had a fully functional auto-enroll with a straightforward opt-out. I’m hand-waving operational challenges away to think this through. As I see it, most people in this group would not see anything different.
Four out of the five pathways lead to a status quo outcome. People with an insurance card in their wallet and no utilization don’t care about that insurance card all that much especially if their premiums are effectively zero as the policy is paid for by non-transferable tax credits.
The one pathway where there is a departure from current status quo is when someone does not opt-out and has utilization. Here they can either present or not present their insurance card. If they don’t present, they are back to status quo. If they do present, they’ll probably be better off if the service is for cancer treatment but they may or may not be better off if the service is for something low level that they could afford to pay for with cash. Odds are they will stay be paying for that service with cash as there is a large deductible that they need to satisfy.
And yes, I am using a material well being analysis to try to understand psychological anchoring so that might be my problem, but I am struggling with this right now to see how big of an issue it could actually be.
Finally, the appropriate musical response to future conditional reactions to gut-check hypothetical questions is below the fold: