Automatic Enrollment Research Articles

Commentary] Building a digital republic to reduce health disparities and improve population health in the United States

Income, schooling, and healthcare are key ingredients for optimizing human’s ecological niche for survival. But most government programs that are designed to provide a hand up in these domains are difficult to access. While many Americans struggle to pay taxes, few understand the difficulties associated with enrolling in Medicaid, Temporary Assistance for Needy Families. A remarkably small percentage of needy families receive the social benefits to which they are entitled, and that percentage is smaller for those most in need (those with physical disabilities, caregiving responsibilities). To address this problem, the Child Tax Credit in the American Rescue Plan provided automatic enrollment and worked hard to locate more low-income families. But until everyone has a digital footprint that allows automated enrollment, the sickest and most vulnerable citizens will remain in the informal sector. By expanding data systems so that all Americans have a digital identity across multiple datasets, it not only becomes possible for all Americans to simplify their lives but for welfare services to work for the most vulnerable, as they are intended. This commentary explores how creating a digital republic might improve population health and reduce health disparities in the US.

Commentary] Building a digital republic to reduce health disparities and improve population health in the United States

Income, schooling, and healthcare are key ingredients for optimizing human’s ecological niche for survival. But most government programs that are designed to provide a hand up in these domains are difficult to access. While many Americans struggle to pay taxes, few understand the difficulties associated with enrolling in Medicaid, Temporary Assistance for Needy Families. A remarkably small percentage of needy families receive the social benefits to which they are entitled, and that percentage is smaller for those most in need (those with physical disabilities, caregiving responsibilities). To address this problem, the Child Tax Credit in the American Rescue Plan provided automatic enrollment and worked hard to locate more low-income families. But until everyone has a digital footprint that allows automated enrollment, the sickest and most vulnerable citizens will remain in the informal sector. By expanding data systems so that all Americans have a digital identity across multiple datasets, it not only becomes possible for all Americans to simplify their lives but for welfare services to work for the most vulnerable, as they are intended.

Commentary] Building a digital republic to reduce health disparities and improve population health in the United States

Income, schooling, and healthcare are key ingredients for optimizing human’s ecological niche for survival. But most government programs that are designed to provide a hand up in these domains are difficult to access. While many Americans struggle to pay taxes, few understand the difficulties associated with enrolling in Medicaid, Temporary Assistance for Needy Families. A remarkably small percentage of needy families receive the social benefits to which they are entitled, and that percentage is smaller for those most in need (those with physical disabilities, caregiving responsibilities). To address this problem, the Child Tax Credit in the American Rescue Plan provided automatic enrollment, and worked hard to locate more low-income families. But until everyone has a digital footprint that allows automated enrollment, the sickest and most vulnerable citizens will remain in the informal sector. By expanding data systems so that all Americans have a digital identity across multiple datasets, it not only becomes possible for all Americans to simplify their lives but for welfare services to work for the most vulnerable, as they are intended.

Effects of Medicaid Automatic Enrollment on Disparities in Insurance Coverage and Caregiver Burden for Children with Special Health Care Needs.

We analyze how Medicaid automatic enrollment policies for children with special health care needs (CSHCN) who are enrolled in Supplemental Security Income (SSI) reduce disparities in health insurance coverage and caregiving burden. Using the 2009-2010 National Survey of Children with Special Health Care Needs, we implement a difference-in-differences regression model comparing insurance enrollment rates between CSHCN receiving SSI and CSHCN not receiving SSI, in states with and without automatic enrollment policies. We find that Medicaid automatic enrollment has a meaningful impact on insurance enrollment for low-income CSHCN who participate in SSI and can be an effective method for mitigating disparities in insurance coverage (reducing uninsurance by 38%). Medicaid automatic enrollment also reduces caregiver burden among socioeconomically disadvantaged families with CSHCN. The effects of these policies are largest families who might be on the margin of eligibility or who face high administrative burden.

Development and Evaluation of a Pharmacist-Driven Vitamin D Protocol for a Cystic Fibrosis Clinic.

Vitamin D deficiency is commonly found in patients with cystic fibrosis (CF) and can have a negative effect on patients who are not at target goal according to Cystic Fibrosis Foundation's Vitamin D Deficiency Clinical Care Guidelines. The objective of this study is to determine the effectiveness of a pharmacist-driven vitamin D protocol (PDVDP) in improving, achieving, and maintaining 25-hydroxyvitamin D levels of patients in a pediatric CF clinic. A retrospective chart review was conducted for pediatric patients with CF from August 2018 to March 2020 to determine the percent of patients with improvement in 25-hydroxyvitamin D levels to target goal (≥ 30 ng/mL). Patients' 25-hydroxyvitamin D levels at 6, 12, and 18 months after automatic enrollment into the PDVDP were compared to determine if improvement occurred, and to calculate relative percent increase of 25-hydroxyvitamin D levels for these patients. The mean 25-hydroxyvitamin D levels of the patients at baseline before the protocol and 6, 12, and 18 months after enrollment in the protocol were 23.2, 33.3, 32.7, and 34.6 ng/mL, respectively. These results demonstrate mean 25-hydroxyvitamin D levels at all follow-up time points were significantly greater than baseline (p < 0.001). At 6 months, 50% (n = 20) of pediatric patients reached the target 25-hydroxyvitamin D levels. The PDVDP was effective in increasing the number of patients able to reach target 25-hydroxyvitamin D levels. Our PDVDP process may also be used at other CF clinics to improve vitamin D outcomes collaboratively with the interprofessional CF team.

The impact of an employer match and automatic enrollment on the savings behavior of public-sector workers

AbstractWe use administrative data on federal civilian workers' accounts in their employer-provided defined contribution plan, called the thrift savings plan (TSP), to provide new evidence on the effects of employer matching and defaults on workers' savings behavior. The empirical analysis relies on exogenous variation stemming from two natural experiments caused by policy changes to the TSP: the establishment of an employer match for workers hired after 1983 and the introduction of automatic enrollment for workers hired after July 2010. We find that the introduction of the employer match lead to a higher increase in both participation and contribution rates compared to the subsequent switch to automatic enrollment. In terms of portfolio allocations, we find that matching and automatic enrollment had small and minimal effects, respectively.

Intensive physical therapy after emergency laparotomy: Pilot phase of the Incidence of Complications following Emergency Abdominal surgery Get Exercising randomized controlled trial.

Postoperative pneumonia and delayed physical recovery are significant problems after emergency laparotomy. No randomized controlled trial has assessed the feasibility, safety, or effectiveness of intensive postoperative physical therapy in this high-risk acute population. The internal pilot phase of the Incidence of Complications after Emergency Abdominal Surgery: Get Exercising (ICEAGE) trial was a prospective, randomized controlled trial that evaluated the feasibility, safety, and clinical trial processes of providing intensive physical therapy immediately following emergency laparotomy. Fifty consecutive patients were recruited at the principal participating hospital and randomly assigned to standard-care or intensive physical therapy of twice daily coached breathing exercises for 2 days and 30 minutes of daily supervised rehabilitation over the first 5 postoperative days. Interventions were provided exactly as per protocol in 35% (78 of 221 patients) of planned treatment sessions. Main barriers to protocol delivery were physical therapist unavailability on weekends (59 of 221 patients [27%]), awaiting patient consent (18 of 99 patients [18%]), and patient fatigue (26 of 221 patients [12%]). Despite inhibitors to treatment delivery, the intervention group still received twice as many breathing exercise sessions and four times the amount of physical therapy over the first 5 postoperative days (23 minutes [interquartile range, 12-29 minutes] vs. 86 minutes [interquartile range, 53-121 minutes]; p < 0.001). One adverse event was reported from 78 rehabilitation sessions (1.3%), which resolved fully on cessation of activity without escalation of medical care. Intensive postoperative physical therapy can be delivered safely and successfully to patients in the first week after emergency laparotomy. The ICEAGE trial protocol resulted in intervention group participants receiving more coached breathing exercises and spending significantly more time physically active over the first 5 days after surgery compared with standard care. It was therefore recommended to progress into the multicenter phase of ICEAGE to definitively test the effect of intensive physical therapy to prevent pneumonia and improve physical recovery after emergency laparotomy. Therapeutic/Care Management; Level II.

Reducing Ordeals Through Automatic Enrollment: Evidence from a Health Insurance Exchange

Reducing Ordeals Through Automatic Enrollment: Evidence from a Health Insurance Exchange

Worker and Spousal Responses to Automatic Enrollment

Worker and Spousal Responses to Automatic Enrollment

Worker and Spousal Responses to Automatic Enrollment

Worker and Spousal Responses to Automatic Enrollment

Auto-Enrollment Pension in Poland: Impact on HRM Strategies and Pension Participation Rates

The study aims a critical analysis and preliminary assessment of chosen effects of the implementation of a new type of occupational pension schemes with automatic enrollment: the Employee Capital Plans (PPKs), successively has introduced in Poland since 2019.

Practical Applications of Do Advisors Improve 401(k) Plans?

In <b><i>Do Advisors Improve 401(k) Plans?</i></b> from the Spring 2021 issue of <b><i>The Journal of Retirement</i></b>, author <b>David Blanchett</b> of <b>PGIM DC Solutions</b> examines the impact that advisors can have on the management and performance of 401(k) plans. Whereas previous research has focused on investment-related outcomes, Blanchett takes a more holistic approach, exploring differences between advised and non-advised plans across a variety of domains. Blanchett begins with a high-level description of the role advisors play in the administration of 401(k) plans before identifying a base dataset of 401(k) plans. The ensuing analysis examines the base dataset in terms of the impact that advisors have on default investment availability and usage, plan governance, the adoption of automatic enrollment, the inclusion of employer securities, and fund diversity, before performing a more traditional investment analysis. Although the results of the analysis are not conclusive for larger 401(k) plans, Blanchett’s research suggests that advisors can add real value, especially for smaller 401(k) plans.

How Do Defaults Affect Behavior of Individual Retirement: Evidence from Ankara

Turkey is one of the few countries that has introduced national-level automatic enrollment in private pension systems to encourage people to save for retirement. Although the policy's effectiveness is debatable, it is fair to conclude that it has accelerated enrolment in individual pension plans. This is due to the fact that defaults have a significant impact on saving behavior. However, there are few empirical data that explain how defaults operate. To find out, we created a survey for Ankara public employees in order to explore possible demographic, financial, and behavioral constructs for automatic enrollment choices. Gender, marital status, and the number of dependents in the family all have an impact on the decisions. Other noteworthy findings concern behavioral constructs: Ankara public employees who find individual pension systems complex are more likely to opt out, and the public authority endorsement effect greatly reduces the risk of quitting the system. These findings show that there is a need for more educational and informational efforts on the pension system, and that policymakers have a significant amount of responsibility as a result of this strategy.

Is automatic enrollment consistent with a life cycle model?

AbstractWe examine retirement saving for young adults in a life cycle model. We find that optimal retirement saving is zero for liquidity‐constrained young adults who anticipate significant earnings growth. With a plausible age‐earnings profile for college‐educated workers, retirement saving does not begin until the late 30s or early 40s. Workers facing a flat earnings profile begin saving much sooner. Participating may be optimal for younger workers facing steep earnings profiles if they anticipate switching jobs and cashing out after 1–2 years. Our results suggest that automatically enrolling workers, regardless of age, is not consistent with a life cycle model.

Eligible but Not Enrolled: Consequences of Forgoing Prescription Drug Subsidies Among Low‐Income Medicare Beneficiaries with Diabetes

Research ObjectiveTo estimate take‐up of the Part D Low‐Income Subsidy (LIS) among Medicare beneficiaries with diabetes, and to examine differences in out‐of‐pocket costs and prescription drug use between enrollees and LIS‐eligible non‐enrollees. The LIS lowers prescription drug costs for Medicare beneficiaries with incomes ≤150% of the Federal Poverty Level (FPL), and caps out‐of‐pocket costs for beneficiaries with incomes ≤135% of FPL. Although a number of recent policy proposals seek to address rising drug costs, the LIS itself remains underutilized. The value of forgoing this benefit among chronically ill beneficiaries has not previously been studied.Study DesignWe used data from the Health and Retirement Study (HRS) to estimate take‐up of the LIS among Medicare beneficiaries with diabetes. Using propensity score‐weighted analyses, we compared out‐of‐pocket costs, prescription drug use, and cost‐related drug non‐adherence among LIS enrollees and eligible non‐enrollees. We stratified the analyses according to whether respondents' income was ≤100% vs. &gt;100% to ≤150% of FPL because of differences in the generosity and take‐up of Medicaid benefits above vs. below 100% of FPL, and because individuals with Medicaid automatically receive the LIS.Population StudiedCommunity‐dwelling HRS respondents surveyed biennially between 2008–2016 who were enrolled in Medicare Part D, had an established diagnosis of diabetes, and were eligible for the LIS (income ≤150% FPL and assets below LIS limit).Principal FindingsAmong Medicare beneficiaries with diabetes, 56.9% of those with incomes &gt;100% to ≤150% of FPL received the LIS, while 90.3% of those with incomes ≤100% received the LIS, reflecting automatic enrollment from Medicaid. Based on these take‐up rates, we estimate that 322,746 LIS‐eligible individuals with diabetes do not enroll in the LIS annually. For those with incomes &gt;100% to ≤150% of FPL, compared to LIS enrollees, eligible non‐enrollees incurred higher annual out‐of‐pocket drug spending ($518, p &lt; 0.001), had 20% fewer fills for diabetes, hypertension, and hyperlipidemia prescription drugs (p = 0.003), and were 9 percentage points more likely to report skipping drugs due to cost (p = 0.04).ConclusionsA substantial proportion of Medicare beneficiaries with diabetes are eligible for but not enrolled in the LIS. Low take‐up was concentrated among beneficiaries with income &gt;100% to ≤150% of FPL. Forgoing the LIS was associated with higher out‐of‐pocket costs and cost‐related non‐adherence, and lower use of medications used to treat chronic conditions. Our findings demonstrate the extent to which out‐of‐pocket costs may be reduced, and use of chronic disease medications increased, if a higher proportion of LIS‐eligible Medicare beneficiaries receive this benefit.Implications for Policy or PracticeProposals to lower out‐of‐pocket drug costs for Medicare beneficiaries often overlook the fact that existing prescription drug subsidy programs are underutilized. Because the LIS reduces cost sharing for all Part D covered drugs and caps annual out‐of‐pocket costs for most recipients, increasing LIS take‐up would likely provide better financial protection for seniors with chronic conditions than a flat subsidy or price caps limited to certain drugs. Policies to streamline or automate LIS enrollment for low‐income Medicare beneficiaries could help to mitigate the impact of rising drug costs in this vulnerable population.Primary Funding SourceAgency for Healthcare Research and Quality.

The Missing Politics of UK Pensions Provision

AbstractPensions provision in the UK has been undergoing upheaval for several decades, as an already liberal regime has gradually been further liberalised, resulting in the rollout of defined contribution provision via the pseudo‐compulsory automatic enrolment system. Yet, the system is dysfunctional, insofar as it replaces the institutional guarantors essential to pensions provision with hazy notions of individual responsibility. The ability of capitalism to reproduce itself is jeopardised as a result. Increasingly, the state, despite scaling back the state pension system, is intervening to subsidise and substitute for a marketised system. Despite the significant risk of poor outcomes for millions of savers in the automatic enrolment system, and the integral role of the state in private provision, pensions policy receives little attention in political debates, or by political scientists. This is driven in part by a lack of salience among the public, which is itself a result of the peculiar temporality of pensions. Yet it is a product also of the disciplinary norms of political science, and the positionality of political scientists.

Borrowing to Save? The Impact of Automatic Enrollment on Debt

ABSTRACTDoes automatic enrollment into a retirement plan increase financial distress due to increased borrowing outside the plan? We study a natural experiment created when the U.S. Army began automatically enrolling newly hired civilian employees into the Thrift Savings Plan. Four years after hire, automatic enrollmentincreases cumulative contributions to the plan by 4.1% of annual salary, but we find little evidence ofincreased financial distress. Automatic enrollment causes no significant change in credit scores, debt balances excluding auto debt and first mortgages, or adverse credit outcomes, with the possible exception of increasedfirst‐mortgage balances in foreclosure.

Target-date funds and portfolio choice in 401(k) plans

AbstractTarget-date funds in corporate retirement plans grew from $5 billion in 2000 to $734 billion in 2018, partly because federal regulation sanctioned these as default investments in automatic enrollment plans. We show that adopters delegated pension investment decisions to fund managers selected by plan sponsors. Inclusion of these funds in retirement saving menus raised equity shares, boosted bond exposures, curtailed cash/company stock holdings, and reduced idiosyncratic risk. The adoption of low-cost target-date funds may enhance retirement wealth by as much as 50% over a 30-year horizon.

What Can We Learn About Automatic Enrollment Into Pensions From Small Employers?

Small employers employ significant fractions of the workforce, but their employees typically have very low pension plan participation rates and so are much more likely to be affected by government polices requiring automatic enrollment. We examine the first nationwide policy in the United Kingdom obliging small employers to enroll employees automatically into a pension. Exploiting pseudorandom variation in its introduction, we find automatic enrollment increased pension participation by 44 percentage points, reaching 70 percent — still substantially lower than the 90 percent rate among those working for the largest employers. We discuss evidence for the potential mechanisms that drive this lower participation rate.

Use of Formal and Informal Food Resources by Food Insecure Families in Lima, Peru: A Mixed-Methods Analysis

The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use – FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.