This is how you let people know what the ACA has to offer

According to a recent Kaiser Family Foundation survey, 53% of the uninsured don't know that the ACA provides financial help to low and moderate-income Americans to help them get insured. Last year, visiting Healthcare.gov or state exchanges didn't always alleviate the ignorance. An April 2014 McKinsey & Co. survey found that two thirds of subsidy-eligible respondents who visited the federal exchange,  remained uninsured and cited unaffordability as the reason did not know that they were eligible for subsidies.

I've asked before how so many visitors to Healthcare.gov could come away not knowing that their coverage would be subsidized. One answer: most did not find their way to the shop-around feature, which enables a user to enter a handful of data points (home location, household members with ages, and household income) and get plan price quotes with the subsidy included (or a notice that the user is likely eligible for Medicaid).  The shop-around was not functional until December 2013 -- and from that point on,while it wasn't exactly buried, it was hiding in plain site among several other potential starting points on the hc.gov home page.

This year it's different. The shop-around itself is streamlined a bit -- but more important, the home page steers users to it. "See plans and prices" is one of just two prominent options on the home page -- the one on the left, where reading starts.  If you pick the other -- "get started" -- you're prompted for your home state, after which you're again presented with a binary choice: see plans and prices, or apply now. "See plans and prices" is a bigger button.

In the same vein, email encouraging shop-around is pushed out to those who have created logins but have not enrolled in a health plan, either last open season or for 2015. I created a login last year, though I get my insurance elsewhere. This afternoon I received an email that looks like this:

View in browser | This newsletter created and distributed by Centers for Medicare & Medicaid Services Cyber Monday: Shop for health plans today This Cyber Monday, don’t forget to shop for health plans on HealthCare.gov. Getting covered may be cheaper than you think and you could be eligible for lower premiums and out-of-pocket costs. Take charge of your health care this holiday season. You’re on your way to the best gift of all – peace of mind for you and your loved ones. Get started today! Just enter your zip code to preview 2015 plans and estimated prices. Remember: Act by December 15 and your new coverage can start as soon as January 1 The HealthCare.gov Team

That big fat button leads straight to the shoparound, which begins with a zip code prompt. If you enter the requested info, you can get subsidy-inclusive price quotes within 30 seconds. That should give some uninsured people at least an understanding that "the government will help pay for coverage for low and moderate income Americans."

Now, if only the hc.gov shop-around would default results to silver for those eligible for Cost Sharing Reduction.  Calling Kevin Counihan....

Healthcare.gov 2.0 is live. A couple of problems...

Healthcare.gov's shop-around feature for 2015 went live last night. While there are some notable improvements, I see a couple of problems that I want to highlight right away.

In the quest to design a website that helps people find the health insurance that's right for them, there's a tension between making the process easy and providing essential information. The new shop-around has come down on the side of "more info" than the prior one. But the info is not always more accessible.

First problem: sometime in the off-season, on the shop-around feature, hc.gov added pop-up definitions of "deductible" and "out-of-pocket maximum" and "co-payments/co-insurance" on all price quotes. Inexplicably, they're gone in the 2015 shop-around.  Maybe they'll be coming online shortly? (Shop-around for the remainder of 2014 is still live if you want to compare.)

Whaddaya mean, you didn't know about the subsidy? --Improving healthcare.gov

Once healthcare.gov stopped crashing, how successful was it in transmitting the most basic information to most users -- how much they'd be likely to pay in monthly premiums, and how much in out-of-pocket costs they'd be on the hook for?

My sense from late December on was that the website's shop-around feature, enabling a user to get that basic information without registering or applying, worked reasonably well. I used it all the time to check premiums, deductibles and maximum out-of-pocket (OOP) costs for different ages, income levels and locations. You need to enter about eight pieces of information, including state and county, household size, household members' ages, and household income, to get a listing of available plans, ranked lowest premium to highest, and sortable by metal tier. Each plan summary clearly lists what you'll pay in premium, deductible and OOP max (if your income estimate is accurate). Cost Sharing Reduction (CSR) subsidies lowering deductibles and OOP, available to those earning under 250% of the Federal Poverty Level, are figured in.

And yet, many people who tried to use the site came away with no idea how much they would need to pay -- that is, how big a premium subsidy they eligible for, let alone CSR, or even that they were eligible for subsidies at all. A McKinsey study found that 72% of the respondents who reported that they shopped but did not buy were subsidy-eligible, and that 66% of subsidy-eligible respondents who cited perceived affordability as the reason they stopped shopping were aware of neither their eligibility nor the amount for which they were eligible. Their plight is illustrated by the tale of a newly retired Philadelphia cop who went online and concluded that insurance would cost her $800 per month, -- missing the subsidy that reduced the premium to $135.