By NextBestFitPhase 1: Enactment & build · Step 1.4
Enroll everyone automatically
Months 6–18 for Wave 1, then before each wave · UHA, SSA, IRSDiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Nobody applies. Everyone with a Social Security number or ITIN and a U.S. address is enrolled from existing federal records; others enroll at any provider, Social Security office, or community health center with proof of residence. | ||
| Canada | Residents apply for a provincial health card; most provinces impose up to a 3-month waiting period for new residents. | Gaps for newcomers and people moving between provinces. | Waiting periods create gaps; the plan uses 90 days with emergency coverage. |
| Taiwan | Enrollment is mandatory, tied to household registration; foreign residents join after 6 months. | 99%+ coverage. | Automatic enrollment through existing registries gives near-universal coverage. |
| Spain | Restricted coverage for undocumented immigrants in 2012, restored it in 2018. | Studies linked the 2012 restriction to more ER use and worse outcomes among those excluded. | Excluding residents shifts costs to emergency care. |
Canada
- What they did
- Residents apply for a provincial health card; most provinces impose up to a 3-month waiting period for new residents.
- What happened
- Gaps for newcomers and people moving between provinces.
- Lesson for this plan
- Waiting periods create gaps; the plan uses 90 days with emergency coverage.
Taiwan
- What they did
- Enrollment is mandatory, tied to household registration; foreign residents join after 6 months.
- What happened
- 99%+ coverage.
- Lesson for this plan
- Automatic enrollment through existing registries gives near-universal coverage.
Spain
- What they did
- Restricted coverage for undocumented immigrants in 2012, restored it in 2018.
- What happened
- Studies linked the 2012 restriction to more ER use and worse outcomes among those excluded.
- Lesson for this plan
- Excluding residents shifts costs to emergency care.
More precedent
- Medicare Part A auto-enrollment at 65 for Social Security recipients.
- Taiwan's NHI card; Canada's provincial health cards.