Journalism in the Public Interest

How the Feds Could Fix Their Glitchy Health Care Exchange

It’s simple: Make the enrollment software work like Medicare Part D.


There’s been a lot of talk in recent days about how the glitchy rollout of the federal health insurance marketplace may not mean much IF the developers of are able to turn it around in the next month.

To prove the point, health policy experts point to the 2006 start of Medicare Part D, the prescription drug program for seniors and the disabled, which was also bumpy.

But in a number of ways, it appears the agency that runs the federal health insurance exchange, the Centers for Medicare and Medicaid Services, hasn’t modeled that website after Part D, which it also runs.

Journalists have pointed out that one major problem with the exchanges is that, until Thursday, it did not allow consumers to “window shop,” or look at details of plans, before giving their personal information and being verified as eligible for coverage. Now users can do that.

Part D’s signup site is quite different. Medicare beneficiaries do not have to provide any information about themselves or verify their eligibility to get detailed cost estimates.

Below are screenshots that show how simple the user interface is for those trying to register for a Part D plan (although if you are a senior with health problems or disabled, this too may seem complicated.)

The beginning: Go to the Plan Finder page. While you have the option to enter your personal information, the first choice is to perform a general search in which you simply enter your zip code.

Step 1: The system relies on the user to indicate the type of coverage he or she wants. There’s no complicated verification system at this point.

Step 2: You begin by entering the drugs you take. The website has a search tool that helps correct possible spelling errors and suggest similar drugs.

Step 3: Next you pick the pharmacies you use. Notice at the top how the page generates a drug list ID and password, which lets you come back later and make changes without having to start all over.

Step 4: You get to refine your results based on what’s important to you — for example, your desire to limit your premium or limit your deductible.

Finally: The results. That was fast. Once you find a plan you like, you can go through the enrollment process.

Could the federal exchange have been modeled off the Part D plan finder? Perhaps it will be in the future.

clarence swinney

Oct. 12, 2013, 12:52 p.m.

The history reveals why we need Universal Health Care which is Affordable Health Care. Total Health Expenditure per Capita
New Zealand-$2510
The solutions can be straight forward for they entail utilizing the same methods of cost containment already so successfully used by the single-payer countries that provide better health care to their citizens.
I am tired of paying $500 for a $32 hand held breathalyzer—$600 for $10 worth of gauze—$6000 for two tests and on a blood pressure monitor for 8 hours
Give Affordable Health Care a Fair test over two years. 8.8m tried to register the first day.
800,000 youths are now covered by parents private insurance policy. Eliminate free care via emergency rooms.  Low income consumers will receive tax subsidies to help cover the premiums.

clarence swinney

Oct. 13, 2013, 11:35 a.m.

Millions of our Republicans march into churches to worship Jesus Christ.
The savior who spent his adult years promoting care for the least amongst thee and condemn the greedy wealthy.
The Government is shut down and no help goes to the needy via Meals on Wheels
or local Loaves and Fishes.
Food Stamps have been cut.
We are still killing innocent people in Afghanistan and Pakistan.
The R defeated America Job Bill intended to create/save 4 million jobs.
The R will not increase the debt ceiling even tho the deficit has been cut in half over the past five years.
We continue to build killing machines such as drones.
Yes! Republicans when you worship please get a conversion to care for the least amongst thee.
Go ahead with Tea Party intent to Cut The Government and Cut the Taxes For The Rich.
We are still in the Bush Great Recession.

Elizabeth Wheaton

Oct. 14, 2013, 6:56 a.m.

This is a pretty lame comparison. Part D is a relatively small program involving limited choices and a fraction of the subscribers to ACA.

And then there are the barriers many states have set up to thwart enrollment—it’s a technological nightmare, and I give the site developers a hearty pat on the back for making the progress they have in smoothing out the glitches so far.

Yeah, I hate to point this out, but—like Elizabeth says—we’re probably not talking about a “platform,” where all the data can be fed and, poof, we have an ACA-finder.  That kind of work isn’t hard, per se, but it’s hard when there’s a firm deadline.

That’s partly because the scope is larger to solve the more general problem and nobody wants to pay for a general solution when they only want an instance, but it’s also because insurance companies aren’t exactly motivated to help apples-to-apples comparisons.  And don’t forget that there’s an ongoing cost of keeping the data up-to-date.

It should be done.  Arguably, you’d want what we used to call an “expert system” helping people walk through the choices.  But I doubt it’ll happen any time soon.

It’d be a great little business while we wait, though, especially if you could scale better than the official ACA site.

This article is part of an ongoing investigation:
Obamacare and You

Obamacare and You

The Rollout of the Affordable Care Act has been marred by glitches and political opposition.

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