Effortless Enrollment Saves Taxpayers $ and Helps Uninsured Children Access Medicaid and CHIP – Say Ahhh! A Children’s Health Policy Blog


Robert Nelb, MPH Candidate 2009, Yale University, Senior Fellow, The Roosevelt Institution

As readers of this blog know, we became fans of Nelb’s work when we came across a letter-to-the-editor he wrote regarding pointless paperwork.  Robert is a senior fellow for The Roosevelt Institution and the winner of the Brookings Institution’s Hamilton Project Economic Policy Innovation Prize.
Anyone who has worked to enroll eligible families into public health insurance programs knows that the application process is an uphill battle. Despite valiant efforts to simplify application forms, about 10 million uninsured children and adults are still eligible but not enrolled in Medicaid or CHIP. So in a new paper for the Brookings Institution’s Hamilton Project, I asked the simple question: why do we need application forms anyway?
This question first came to me a few years ago, when I was working as a health outreach volunteer in Connecticut, trying to explain the pages and pages of forms to low-income families. Frustrated by all this bureaucracy, I decided one day to take a closer look at the fine print on the last page of Connecticut’s application, and I found, to my surprise, that states already know who is eligible. All that information that we enter each year on our tax forms, all the automatic withholding on our wage stubs and all the data that we enter at the department of motor vehicles are part of a secure data system that all states have been using for years to verify eligibility in public programs. The paper forms and bureaucratic barriers are just an obstacle course for families to show that they really do want coverage.
Now I have never met parents who didn’t want health care for their child, so I asked the next logical question: Why doesn’t the government use all this existing information to automatically enroll eligible families in public programs without the need for an application form? Findings from behavioral economics suggest that opt-out policies are much more effective than opt-in ones. Moreover, this strategy has long been used successfully for Medicare Part B to give senior citizens the benefits that they deserve. For once, Congress actually agreed with me, and as a result of the hard work of many, many advocates, a new state option for automatic enrollment was included in the recent Children’s Health Insurance Program Reauthorization Act (CHIPRA).
Some policymakers may say that they cannot afford to pay for the millions of uninsured Americans who are already eligible for public health insurance programs. But as I dug deeper, I found that all the administration and paperwork for means-tested programs cost taxpayers tens of billions of dollars a year. States that have reduced the need for application forms have been able to cut enrollment costs by more than half, which allows more taxpayer money to go directly to families in need. By my estimates, a fully implemented automatic enrollment policy would cover nearly all eligible beneficiaries and save about $3.2 billion in unnecessary administrative costs each year. CHIPRA also includes bonus payments to states who implement automatic enrollment policies, making it easier than ever for states to finally close the gap in enrollment for public health insurance programs.
As policymakers consider proposals to expand health care coverage to all Americans, the lessons of effortless enrollment are important to remember. Politicians may disagree on questions of big government or small government, but hopefully we can all agree that good government is good policy for America’s families.
The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.

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