Republican legislators and policy experts are kicking around a novel way to increase health coverage: automatically enrolling millions of uninsured Americans into low-cost insurance plans.
And unlike Republicans' other ideas, automatic enrollment is the rare health proposal that doesn't reflexively alienate liberals. They are generally enthusiastic about policies that would lead to greater coverage.
"It's a viable idea," says Andy Slavitt, who ran Medicare under President Obama and is an ardent Affordable Care Act advocate. "What's appealing about it to Republicans and to Democrats is you want people to have free choice but not be free riders."
"It's an interesting idea that has got a lot of promise, but the operational details need to be worked through," says Stan Dorn, a senior fellow in the Health Policy Center at the Urban Institute, a think tank generally supportive of the Affordable Care Act.
The goal of an automatic enrollment program would be to increase coverage and lower premiums by getting younger and healthier people signed up for coverage. The government would pick a plan for uninsured Americans with premiums equal to the size of their tax credits, meaning they wouldn't pay anything out of pocket.
An automatic enrollment plan would have an opt-out option, senators say. But research on other similar programs suggests most people won't use it — that they'll stay in their no-cost health plan.
"We want to get more people into the pool and that obviously makes it better for everybody," says Sen. John Thune (R-SD), who has advocated for a discussion of the issue in the Senate working group.
There are significant logistical obstacles to setting up an automatic enrollment program — namely, how to set up a database of all Americans who currently lack insurance. But the idea is gaining traction on Capitol Hill at this point, as senators explore how to create a bill that covers more people than the House's proposal.
"There was a nice discussion the other day about how senior Republican aides think that auto-enrollment is the direction we should go in," says Sen. Bill Cassidy (R-LA), an early advocate for the policy. "On the left, Andy Slavitt said auto-enrollment could be a way to get there. We're changing the conversation."