Thursday, September 18, 2014

If you answer the first question wrong on healthcare.gov, no soup(sidy) for you

Back in April, when the ACA's extended open season was finally over, surveys conducted by McKinsey & Co. and PerryUndem (for EnrollAmerica) indicated that most of the still-uninsured were eligible for ACA subsidies (or Medicaid, in expansion states) but didn't know it. In fact, McKinsey found that two thirds of subsidy-eligible respondents who visited healthcare.gov but did not enroll were not aware of their eligibility -- and so had no idea how much health insurance would actually cost them.

I have an article up at The New Republic (my first there) examining why so many of the uninsured remain unaware of what the ACA has to offer them. In all fairness, the first answer must be that knowledge penetration takes time -- the CBO always projected a 3 to 4-year path to full takeup.


Secondly, more professional help for users is desperately needed, whether from certified navigators or brokers (California came to rely heavily on the latter). Insurance is complicated. Of course, states that stonewalled on implementation left outreach and aid entirely to private organizations -- and some  holdout states, like North Carolina, have much more extensive private social service resources than others.

The third means of better communication is a cleaner, simpler, more informative user experience at healthcare.gov and the state exchanges. That is the focus of the TNR article. It begins with one startling fact: if you started an application on healthcare.gov and took a false step at the first substantive question asked...no subsidy for you! You'd end with a a shopping screen showing the full sticker prices of all available plans.

Relatedly, the site did not aggressively steer visitors to the "see plans before I apply" feature, which asks a handful of questions, including household income, and then shows price quotes with estimated subsidy included.

Beyond that basic get-oriented point of entry -- what's the least that insurance might cost me? -- I examine two routes to improving user experience: provide more in-context information vs. simplify the experience (see: HealthSherpa). There's an obvious but not necessarily irreconcilable tension between the two.

Anyway, I hope you'll check out the article.

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