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 healthcare.gov 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.

The rougher road to health care cost control

There may be an ironic turn of the screw in the argument of an Urban Institute health policy paper by Robert Berenson, John Holahan and Stephen Zuckerman that a "hard trigger" for a strong public option may have a better chance of controlling health care inflation than the weak public options currently included in the House and Senate bills (an argument that Ezra Klein calls "as clear-headed on the public option as anything I've read').

The core argument is this: health care costs are out of control mainly because hospitals and doctors have undue pricing power in many markets. The main potential of a public option for controlling costs lies in exploiting Medicare's pricing power by tying public option payment rates to Medicare's - which neither the House nor Senate public option does. The current weak public option provisions could be negotiated away in favor of a well designed "hard trigger" -- one that goes into effect automatically if either plan pricing or overall health care cost control targets aren't met. Such a trigger would presumably mandate a strong public option with the right kind of pricing power.  Moreover, that trigger should go into effect by 2014, when the exchanges have barely got started -- so little or no time would be lost.