Shocker: Health-Exchange Websites Can Be Done Right

In the last few days, you might have seen a news story about something called Thehealthsherpa.com. The story usually goes like this: "The federal government may have screwed up when it tried to create the Obamacare website, despite spending hundreds of millions on contractors. That's why three tech geeks thought they could do a better job. And after just a week of coding, they did it."

So have these guys solved all our problems? Is it now a piece of cake for everyone to find out what their insurance options are on the individual market? That would sure be a good thing, especially since nearly everyone complaining that their plans are being cancelled—the folks whose fate has suddenly become the most important moral and practical crisis facing America—seems to be taking their insurers at their word when they get those threatening letters instead of trying to find out what their choices actually are.

The answer is ... sort of, maybe.

Thehealthsherpa.com isn't actually the only site that has tried to gather up this information so people could see it easily (here's another one, using all the web-design magic available in 1995). But since they're the one getting the attention, let's see what you can get from them, and how it compares to what's necessary to get the same information from the federal government and the states.

Before we start, it should be noted that what they've done is much more modest than what Healthcare.gov has to do, because they're just giving people the top layer of information, and it's much easier to do that quickly than to do all the things Healthcare.gov has to do on the back end. The federal site has to communicate in real time with hundreds of insurance companies and other government agencies. And when you want to sign up and buy your coverage, it's inevitably a complicated process in which you have to provide a bunch of information. That being said, what the creators of Healthcare.gov failed to understand from the beginning, and what Thehealthsherpa.com folks got, was that people were likely to do a lot of window shopping before they actually made their purchase decisions. Enabling people to do that is both incredibly important and evidently not all that complicated from a programming standpoint.

The administration isn't wrong when they insist that Healthcare.gov is working much better than it was a month ago. But it still sucks, even though technically you can now search for plans. In order to do it though, you have to click through a bunch of screens giving information about the way the law works, and little things take longer (for example, instead of just entering your zip code, it makes you select your state from a drop-down list, then generates another drop-down list of counties for you to select). Healthcare.gov also doesn't give you subsidy information on the same page as where it generates the sample plans; instead, once you see the plans you have to click on a separate link to calculate your subsidy, which opens up a new window with a page of redundant text, which then gives you a link to the Kaiser Family Foundation website's calculator, which opens in yet another window.

In other words, while a month ago you couldn't get plan information at all through Healthcare.gov, now you can, but it's a process made much harder than it should be by absurdly crappy design. Why is it still so awful? My guess is that despite how hard everyone is working to fix it, this is still being produced by big government contractors for whom complexity is the path to profits and simplicity is a threat to their business model (I wrote about this two weeks ago). They seem to be fundamentally incapable of creating something simple and user-friendly, probably because it never even occurred to them that those might be desirable things to have in a website.

So let's get to our test. I picked a zip code in a state that isn't running its own exchange (Nebraska) and tried to see what I could learn through Healthcare.gov and Thehealthsherpa.com. I put in for a family of two 45-year-old adults and one child, with an income of $50,000 a year. It took about 30 seconds to go through Thehealthsherpa.com's process and come up with plans. Piece of cake.

On Healthcare.gov, if you click through quickly without bothering to read all the informational pages that pop up, you can get to some prices in about a minute, which isn't so bad. But then you have to go out to the Kaiser site to calculate your subsidy, and after spending another two minutes or so entering information there, I got a figure for a silver plan in Nebraska—$4,112 per year for this sample family of three—but that's based on a percentage of my income and makes reference to silver plans generally but not to any particular plan. Now I have to start going back and forth between the page on Healthcare.gov with the different options and the Kaiser page to try to figure out what I'm going to pay. I've been writing about health reform for almost five years now, and I found it confusing. Imagine how someone encountering all this for the first time would do. The fact that you can't get subsidy information on Healthcare.gov itself that connects directly to the actual plans you might buy to give you an accurate dollar amount is just ridiculous.

All right, but what about the state exchanges? How do they do? There are some that have been having problems, but there are also some that are reportedly working quite well. So I tried Kentucky's, supposedly one of the ones that works well, using the same demographic. It took about five minutes of entering in separate information for each person, but when I got prices for the plans, it didn't include what I could get in subsidies—to integrate that information, I'd actually have to register.

I tried a couple of other state exchanges, but kept running into the same problem: If I wanted to compare plans, I'd have to register. This was true in Maryland, Vermont, Colorado, and New York, which told me happily, "You can create an account online though the NY.GOV site. Once you provide an email address and some information about yourself, you'll get an email invitation to the Marketplace site and can get started!" My very own invitation? Wow, thanks a lot.

My patience waning, I didn't try the site of every state that has their own exchange. But because I had been there before and knew it worked, to make myself feel better I went to California's site. Like Thehealthsherpa.com, it was simple, intuitive, and to enter in the required information and compare plans, including what I'd get in subsidies, took only 30 seconds.

So what does all this tell us? Maybe a lot of things, but I just want to note two. First, creating an exchange that makes it easy to get the first layer of information people want is completely doable. If California did it, other states can too. Sure, actually applying to get your plan is going to be more complicated, but the first thing people encounter when they begin the process shouldn't be a brick wall.

And second, I strongly suspect that Healthcare.gov is never going to be easy to use. That doesn't mean the catastrophic problems like the site seizing up when it has too many users won't be solved, and it doesn't mean that people won't be able to complete their applications without tearing their hair out. But there's little evidence so far that the contractors who created it are capable of designing something that's genuinely easy to use. In the end, it'll probably be sufficient, but not nearly as good as it could be.

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