Thursday, February 27, 2014

Just how will Health Sherpa simplify ACA signup?

UPDATE: Health Sherpa is now live taking QHP applications, routing the subsidy application through but claiming to streamline the process. The next post explains how an application initiated on Sherpa differs from one executed entirely on 
I am  glad to read that HHS is partnering with Health Sherpa, one of the first ACA comparison-shopping sites to turn up while was dysfunctional, to provide an alternate channel enabling people to sign up for Qualified Health Plans offered on the ACA exchanges. But the Washington Post story reporting the arrangement includes some misinformation and leaves the advantages unclear.

According to the Post's Brian Fung:
In November, the Department of Health and Human Services met with [Health Sherpa co-founders George Kalogeropoulous and Ning Liang]  to explore how to turn sites like theirs into a "modular" system -- where third parties could sit on top of the federal data hub and act as another online storefront for Obamacare.

Now, the integration is complete — making it possible to sign up for Obamacare using the Health Sherpa's Web site. Unlike, which was criticized for making visitors enter much of their personal information before verifying their subsidy eligibility and then showing them available plans, Health Sherpa  allows people to window-shop without entering much more than their Zip code, age and income.

It's not true that you have to enter intrusive personal information on to comparison-shop. The shop-only feature is excellent and has been fully functional at least since late December. -- just about as easy as on Health Sherpa. You answer seven questions, and you're in -- able to view all available plans, fully priced with subsidy calculated according to your income estimate, and with access to plan details. No personal information is required (i.e., there's no personal identification attached to your income estimate).

If Health Sherpa is not needed in most states* for easy comparison shopping, what other advantage does it offer?  The Post story implies that Sherpa and other third party sites will be able to streamline the application process, particularly the subsidy application process, but it's not clear how it can do so. Here's the Post account:
"We've reduced the sign-up time by a third to a half," said [Health Sherpa co-founder George] Kalogeropolous. "The verification process works through a shortened version of the flow that we partnered with [the Center for Medicare and Medicaid Services] on."

Health Sherpa still sends visitors to to verify their subsidy. But once that stage is completed, said Liang, the system sends them back. Eventually, HHS intends to release an API that will eliminate that step altogether, so that enrollees will never need to see the Obamacare site. What is now a 30-minute process on Health Sherpa could shrink to 10 minutes or less for the majority of straightforward applications in the future, the founders said.
The bottom line, for now at least, is that subsidy applications still need to go through If Health Sherpa offers a somewhat streamlined gateway, the applicant will still eventually have to provide all the information the federal government requires to verify a subsidy determination. A CMS official confirmed for me that consumers can start an application on an online broker's site, but if a subsidy application is involved, it must be routed through [ [But per the next post, Health Sherpa has its own dedicated interface on itself that elminates some redundancies in the subsidy application process]

It's true, as I've noted before, that those who are not eligible for ACA subsidies can save themselves a bureaucratic step -- and the uncertainty entailed by the exchanges' still somewhat shaky data transmission to insurers -- by buying plans directly from insurers. Going through an online broker is also an option. But that, too, adds an intermediary. It's easy enough to comparison-shop on an ACA exchange (or Health Sherpa or ValuePenguin) for an exchange plan, or on an online broker's site for plans offered off-exchange, and then go directly to the insurer once a plan is selected.

HHS has indicated on occasion that it may eventually allow third parties to take the full subsidy application and send the information directly to the federal data hub. If that day arrives, sites like Health Sherpa will have to collect all the information that now requires [albeit perhaps more efficiently].

The competition may be a boon: perhaps good web design will make the process marginally easier.  But honestly,'s user interface is not badly designed. If Health Sherpa can cut the application time by two thirds, I'd like to hear more about how [again, see followup].

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* Shopping is equally easy on most state exchanges: I have checked out prices with no problem on the California, Colorado, Washington  and Minnesota sites. It is true that some state sites reportedly don't work well. Also, as far as I can tell, the New York site does not enable comparison shopping prior to signup.

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