New York Times

By: Margot Sanger-Katz

In 2003, Washington State was facing a budget crisis and wanted to reduce spending on Medicaid. Instead of requiring people to establish their eligibility annually, the legislature began requiring them to do so twice a year, and added some paperwork. It worked: Enrollment in the health insurance program fell by more than 40,000 children in a year.

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Laura Dague, a professor of health policy at Texas A&M who has studied the effects of small premiums, found that both frequency and cost tend to cause drops in enrollment. “Any time the state requires more contact from the eligible population or enrolled population, you lose people at those places of contact,” she said.

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The Affordable Care Act helped codify that simplification, by requiring all states to use the same definitions of income, to use electronic databases whenever possible, and to eliminate other eligibility rules that made it harder and more time consuming for people to seek coverage. The goal of simplification has been to enroll as many eligible people as possible, and drive down the uninsured rate.

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