Thread by @onceuponA

Every policy person I know who thinks about health insurance is on board with "smart defaults."

I see the primary problems as political (concerning carriers more than individuals) and logistical (including legal questions), not broader public opinion.

https://twitter.com/mattyglesias/status/1338510922390892545

Even with soft-defaults, like indicating that a certain plan is someone's probable "best" option, will get pushback from carriers.

That's because if these nudges worked well—and my prior is that they would—they'd have considerable influence over market share.

I'm not merely speculating here: the Obama administration tried to do an extremely weak version of these nudges, prioritizing standardized "Simple Choice" plans on HealthCare.gov.

Insurers did not love it. nytimes.com/2016/10/18/us/…

I'm a little more out of my depth on the legal concerns (not a lawyer), but this is something I've discussed with policymakers on the ground.

The issue seems to be enrolling people into plans where they have a financial obligation to an insurer could generate lawsuits.

Even if those lawsuits don't have merit, they would be a nuisance to manage. One thought is to just auto-enroll people who qualify for zero-premium plans, but subsidy eligibility is volatile, so the financial obligation could manifest later, and create the same problem.

And then there are the logistical issues of just knowing how much subsidy a person qualifies for, given the byzantine nature of the ACA regs. That's not a small hurdle to overcome.

I absolutely think that this is the direction that policy should go in the current context—and it may be more feasible to do by regulation than a lot of other things that would improve coverage rates.

But auto-enrollment won't be an easy lift. No policy worth doing ever is.