Nice piece but one caveat-- Medicare enrollment is not as simple or automatic as you say here. It is automatic once you're receiving Social Security (either at 65 or after 24 months on SSD) but many people delay Social Security and have health insurance from work. The rules around enrolling after 65 are very complicated and despite recent efforts to simplify legislatively still snare quite a lot of people. One difference is that people over 65 or disabled almost always want to be insured so they generally make the effort. But it's far from the automatic enrollment we should have. Even free Part A isn't truly automatic.

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I believe most of the people who were on Medicaid were automatically enrolled. Most of the ones who will be dropped from Medicaid did not know they had to re-enroll yearly. Either they moved, just plain did not know, understand the process, etc. The states were more than happy to drop them even though much o the cost was paid for by the Feds. The meanness of the Wisconsin government gives even more reason for these people to be automatically enrolled again. The cost of treatment is far less than commercial insurance which something in the realm of 200% of Medicare.

Yes, it is probably the best a state can do which is why the Feds can do better and Single Payor as Kip Sullivan's writes should be the goal. Much of the clerical function and the differences would disappear..

Bill @ Angry Bear

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