title: Enforcing Enrollment in Health Insurance Exchanges: Evidence From the Netherlands, Switzerland, and Germany.
abstract: Experience from the Netherlands, Switzerland, and Germany suggests that there may be a looming problem concerning uninsured individuals and defaulters that could derail coverage projection numbers in the United States under the Affordable Care Act. In those countries, the young, people with migrant backgrounds, and those with lower incomes-precisely the groups the Affordable Care Act is seeking to cover-are overrepresented in the numbers of the uninsured and defaulters, frequently because of difficulty in paying for their premiums. In these three countries, penalties or suspension of coverage alone has not led everyone to purchase coverage or prevented some from defaulting. Help in addressing the vulnerable position of the uninsured may be needed. Examples include using a multifaceted approach in which public authorities help with debt restructuring, freeing some funds in the exchanges to help vulnerable groups, and compensating insurers for their outstanding payments if they follow an agreed protocol instead of canceling coverage.
authors: Berlin University of Technology, Berlin, Germany.
authors: Ewout
authors: E
authors: van Ginneken
authors: University of California, Los Angeles, CA, USA triceucla@gmail.com.
authors: Thomas
authors: T
authors: Rice
mesh_terms: D005858:Germany; D062265:Health Insurance Exchanges / Q000331:legislation & jurisprudence*; D006801:Humans; D009426:Netherlands; D058991:Patient Protection and Affordable Care Act; D013557:Switzerland; D014481:United States
keywords: Affordable Care Act; European countries; health insurance