Tuesday, November 19, 2013

Low-tech glitches on HealthCare.gov

I get that fixing HealthCare.gov dysfunction is a massively complex tech project.  But there are informational flaws on the site -- sins of omission and commission -- that would be easy to fix. I've encountered two.

For the first, call me stupid. There's a hole either in my tech savvy or my reading about ACA implementation -- or both.  But stupidity is rarely rare, and the designers of heatlhcare.gov should have anticipated my need for one really basic piece of information.

From October 1 to November 15, I tried to create a login at healthcare.gov at least 40 times.  For perhaps too long, I assumed that my failure was just the core failure of the site. Gradually, recently, it dawned that whatever the site's functional failures, most people by now could at least log in -- and were encountering further glitches when they tried to complete applications (see comments on this HHS posting). So I went on live chat and quickly learned the cause of failure: if you've blocked access to pop-ups, you have to turn off the pop-up blocker. I did so, and lo, my login is created.

If I needed to buy insurance on the exchanges, I doubtless would have figured this out sooner, by phone or live chat (I've accessed both for other purposes, with no wait time).  It's the first thing they tell you, along with clearing the cache, which I had read about. But shouldn't "turn off your popup blocker" and "clear your cache" be the first things you read when you start the login process? Maybe with the other threshold requirement, an email address, noted, at the bottom of the first login page?

The second flaw is more substantive.  If you shop without logging in, healthcare.gov gives you price quotes that not only don't include your likely subsidy (they refer you to Kaiser's calculator for that -- fair enough) but also don't take your age into account -- and fail to tell you that your age is a factor (as it is in most, but not all, states).  I confirmed this via live chat (I've changed the rep's name, not that she didn't do a fine job, and added the links):
[7:07:17 pm]: Andrew
I have used aggregator sites ValuePenguin and HealthSherpa to get quotes for insurers in NJ on the exchanges, including subsidy calculations. ValuePenguin's are accurate; I check them against the insurer's web postings. I've also shopped on healthcare.gov without logging on, and it seems to give plan prices without age-specific information. My guess is that it's quoting a mid-range age, because quotes are far lower than on the other sites. Is that so?
[7:08:21 pm]: Andrew
..I should add that in an early help session here, a helper told me that prices are not age-specific, and that is not so. They are in most (I think) or at least some states: the ACA merely reduced the degree of variation.
[7:08:57 pm]: Maida
Thank you for your question. It will take me just a moment to review and respond to your question.
[7:09:23 pm]: Andrew
Right, take your time.
[7:14:52 pm]: Maida
Your house hold size, ages and tobacco use and may be lower based on your income. The results you saw were generalities based on your state and country. The only way to get an accurate quote is to fill out an application.

Of course I had to add my two cents:
[7:16:33 pm]: Andrew
Right, that's what I thought. I'm afraid that is a real flaw. I could understand giving prices minus subsidies, but there's no point doing it without age input -- or at least clarifying that the site is showing a general average. It would be very upsetting to find actual prices double what I had been led to believe. I'm writing as a supporter who wants the site and law to work.
[7:17:36 pm]: Andrew
Also, I noted somewhat to my (pleasant) surprise that the site refers users to the Kaiser calculator to get an idea of subsidy eligibility. HHS should now consider referring users to ValuePenguin and/or HealthSherpa.
As I've noted before, the aggregator sites perform all the low-tech functions that healthcare.gov should perform -- that is, ValuePenguin in particular provides all the information needed to shop the exchanges.  The devil is in the transactional functions -- completing the subsidy calculation for real, getting the info to the insurer the user selects, and completing the transaction.  But the SWAT team at CMS should quickly pluck the low-hanging informational fruit -- ideally by matching the functionality of ValuePenguin, adequately by referring users to the the aggregators (as they do to Kaiser for subsidy calculation).

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