Manufacturing Retrospective


“I was on the phone with one of my friends. I saw him pass, and there were 40 to 50 police cars behind,” Shaaban said. Shaaban learned from his friend about the murder suspect behind the wheel. About 15 minutes later, Shaaban was at a red light. The pickup truck had circled back to the area. It drove through a parking lot before moving into Shaaban’s path. The semi-truck driver decided he had to act. “If he passed, I would have blocked all the cops, and he would have run. The second I heard his engine, I floored my truck, and I hit him,” Shaaban said. “I had to end it before he killed someone or hit a car or hit a kid.” Soon after the crash, the suspect was taken into custody. Shaaban, a father of three, believes his big rig, which he bought used five months ago for $75,000, is totaled. He fears insurance won’t cover the damage because he deliberately crashed. “It’s my job. That’s how I make my money and support my family. My whole life depends on this truck,” Shaaban said. However, he says he doesn’t regret his decision. “I would have done it again. Somebody had to stop him. Ultimately, it’s a piece of metal, and I may have saved a life,” Shaaban said. A GoFundMe campaign has been set up to help Shaaban buy a new big rig.

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A file cabinet with color coded folders is seen in a doctor There are a wide range of ways to facilitate auto-enrollment that would have varying impacts. While all options may not be feasible in the short term, state and federal policymakers should move to enact the most streamlined approach possible in their political or economic contexts. States should consider offering streamlined Medicaid enrollment to people receiving or requesting unemployment insurance (UI) benefits and other means-tested programs. 59 Several public benefit programs rely on the eligibility determinations of other programs. 60 For example, Medicaid agencies use Supplemental Nutrition Assistance Program (SNAP) income information to determine eligibility for renewal. The American Rescue Plan, for the first time, extends marketplace subsidy eligibility based on receipt of unemployment benefits. People who attest to receiving unemployment compensation at any point during 2021 will be eligible to purchase marketplace coverage with maximal subsidies. 61 The pandemic presents a key opportunity to think through more permanent connections between coverage and the social safety net. Another option for boosting coverage is allowing people to indicate their uninsured status on their tax returns, which would trigger auto-enrollment or additional outreach. Tax-based auto-enrollment on a federal level would produce the greatest impact, but policymakers would have to make substantial changes, including allowing prior-year income to be used for Medicaid eligibility and eliminating the employer coverage firewall. 62 However, the ACA laid the groundwork for linking federal tax returns to nudges for coverage. Under authority granted by the ACA, the IRS can send notices to taxpayers describing coverage options, connecting them to the marketplace, and even letting them know they are likely eligible for subsidized coverage based on their income the previous year. While the IRS has only once used this authority for outreach, Treasury Department researchers estimate that the 3.9 million letters that the department sent in 2016 to notify uninsured people about the ACA coverage mandate and enrollment options saved 700 lives. 63 More funding could enable the IRS to engage in more robust outreach or share the necessary information with states to conduct that outreach. 64 Maryland is the first state to implement a policy that offers streamlined enrollment and outreach to uninsured tax filers. 65 The Maryland Easy Enrollment Health Insurance Program passed the state legislature by a landslide with bipartisan support and was signed into law by Gov. Larry Hogan (R) in 2019.