For a while now, some conservative health-care wonks have been touting the concept of “automatic enrollment.” The idea is that when someone fails to sign up for health insurance, the government could simply arrange (minimal) coverage for them behind the scenes, using the same subsidy money the person would have gotten if they’d signed up. It’s a less coercive alternative to the individual mandate that, depending on how it was set up and whether it was part of a bigger change to the health-insurance system, could ensure universal coverage.

In December 2017, the Republican Congress, working with the Trump administration, repealed the tax penalties enforcing the Affordable Care Act’s (ACA) individual mandate, effective in 2019. Although the degree of the mandate’s efficacy is uncertain, its repeal is sure to lead to additional Americans going without coverage, exacerbating the instability that now affects the individual insurance markets of many states.

Preventing insurers from pricing premiums based on risk unintentionally increases costs for everyone else in the marketplace. When healthy people refuse to purchase health insurance due to higher costs, it causes insurers to raise prices even further, further disrupting those who are left in the market.