Treating poor people as “passive” health care consumers


By Al Norman

In 2009, a state legislator who chaired the House Financial Services Committee on Beacon Hill introduced a bill that would “automatically enroll all eligible seniors” into a managed care program for seniors.

The chair explained: “The biggest obstacle facing the [managed care] program is reaching the population, which has proven to be a challenge, as eligible seniors tend to be poor, often non-English speaking, and sometimes illiterate.”

The legislator’s solution was to take these “poor, sometimes illiterate” people and push them into health plans they neither understood nor wanted.

Fortunately, that bill went nowhere. But the concept has risen again on Beacon Hill, in a new Senate healthcare cost control bill. Some of these same “passive enrollment” ideas are also found in proposals submitted by Governor Charlie Baker to the federal government.

It has become fashionable in healthcare circles to view seniors and the disabled as “passive” agents in their own healthcare future. The phrase “passive enrollment” is a euphemism for “mandatory enrollment,” because the idea of the government telling people which plan to join is anathema to most Americans.

I testified in 2009 that passive enrollment would “result in many seniors being enrolled in healthcare plans they did not choose or want… Forcing a senior into managed care could be forcing them to change doctors or service providers.”

In July of 2012, 33 national groups wrote to the federal Centers for Medicare and Medicaid Services raising opposition to mandatory enrollment into managed care plans. Groups such as Easter Seals, Families USA, Leading Age, the National Association of Elder Law Attorneys, the National Association of Area Agencies on Aging, and the National Council on Aging, said in their letter:

“We oppose passive enrollment into the demonstrations. Poor, sick individuals with multiple chronic conditions should not be passively enrolled into an experiment; an opt-in enrollment process is most suitable for this population… Free choice of provider has been a tenet of the Medicare program since its beginning …”

In October of 2017, the state Senate introduced language in a healthcare bill that would authorize the state to automatically enroll as many as 9,900 elders in the home care program into a managed care program. The same bill gave public housing authorities the right to automatically enroll their elderly tenants into one or two managed care plans picked by the landlord.

People who are “poor, often non-English speaking, and sometimes illiterate” have enough burdens to bear in our society. Being “passively” swept into healthcare plans you did not choose should not be one of those burdens. All of us should be free to “opt in” to the health care we want. That extends not just to picking our doctor, but picking our health plans as well.

Al Norman is the executive director of Mass Home Care. He can be reached at or 978-502-3794.