Wednesday, July 30, 2014

What's the web got to do with it? -- the uninsured need human help

I have an article forthcoming elsewhere (I hope) that examines why many people who visited remained unaware that they were eligible for subsidies to defray the cost of health insurance. That article is mainly focused on website design, e.g., getting a quick subsidy calculation in front of site visitors.

A new Urban Institute report* drawing on information from Health Reform Monitoring Survey data collected this June spotlights a different aspect of reaching the uninsured: For many, access to expert human assistance is vital.

The report compares the experience of those who were insured in June 2014 but had been uninsured for all or part of the twelve months prior with those who remained uninsured at the time of the survey. While a higher percentage of the still-uninsured used a website as a source of information than of the newly insured (60.3%** vs. 51.1%), "the insured were more likely to use direct assistance assistance than the uninsured" (45.9% vs. 32.1%).  The newly insured were likelier than the still-uninsured to use navigators and application assisters (11.2% vs. 6.4%) or agents and brokers (12.4% vs. 5.1%).***

Those who gained coverage were less likely to use websites exclusively than those who remained uninsured. While that's unsurprising, it is perhaps surprising that 35.5% of those who gained coverage looked for information without using a website at all, compared with only 22.2% of the still-uninsured.

Even more fundamentally, most of those who remained uninsured never looked for coverage at all: just 31.7% looked for information on marketplace plans, and 16.2% had not even heard of them. Overall, only about 40% of those who had been uninsured for all or part of 12 months prior to June 2014 looked for coverage.  Hence, the Urban Institute authors conclude, "For both the uninsured who did not visit the Marketplace and for those who visited but may not have understood the information available, a different and more aggressive outreach and education plan is clearly necessary."

At the same time, as my story-to-come indicates, advances in website design could go a long way toward making subsidy-eligible shoppers quickly aware of how much they're likely to pay per month for insurance -- and also steer them toward optimal choices, given their finances and likely usage of medical services or drugs.

*"Navigating the Marketplace: How Uninsured Adults Have been Looking for Coverage." By Stephen Zuckerman, Michael Karpman, Fredric Blavin and Adele Shartzer, July 29, 2014

** I assume that the 60.3% is from the subset of still-uninsured respondents who sought information by any means at all.

*** Other sources of live-person help were more evenly distributed between the still-uninsured and the newly insured; they include call center help, Medicaid or another program agency, and indirect or informal assistance.

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