Automatic Health Insurance Policies and Coverage Outcomes: Evidence from Massachusetts and Implications for ACA Reforms

How much do small hassles in health insurance enrollment processes affect insurance take-up and coverage outcomes? Can policies that make it easier to get and stay insured have a meaningful impact? We provide evidence on these questions by studying “automatic health insurance” policies used by Massachusetts in its pre-ACA health insurance exchange. The policies’ basic insight is to focus on moments of transition when people face a risk of becoming uninsured unless they complete a minor administrative step. In practice, many people fail to take action at these key moments. Under the policies we study, individuals are automatically assigned to a $0 health plan if one is available, rather than being allowed to passively slide into uninsurance.