Reporter's Notebook

Test Driving The Obamacare Software

By Jay Hancock

June 27th, 2013, 5:53 AM

All the outreach in the world won’t count for much if the Obamacare ticket counter doesn’t work. Behind the campaign to educate the uninsured about the Affordable Care Act is the assumption that software to sell the plans will be ready and user-friendly by Oct. 1, when enrollment is supposed to start. That assumption is not universally shared. Some wonder if systems will be tested and finished on time. Others worry the programs will lead consumers to make dumb insurance choices.

Photo by Ian Barker via Flickr

Kaiser Health News got an early look at Obamacare software that will be deployed in Minnesota, Maryland and the District of Columbia. Connecture is developing the Web interface for consumers under 65 who don’t have employer-based health coverage to shop and sign up for a plan in those states. Connecture isn’t handling the software that qualifies you to buy under the health act or verifies your eligibility for subsidies. Other companies are doing those. Connecture’s piece is the point-of-sale program, the one that steers you through insurance choices and closes the deal.

That process is complex enough by itself. How much coverage do you want? What deductible? Are family members on the plan? Do you need an asthma program? Do you want to keep your current doctor? What about dental?

Health-act proponents liken the signup software to Expedia or Travelocity, where travelers can book flights and hotels. It may be more like TurboTax, escorting you through requirements and choices much more complex than whether you want a flight in the afternoon or the morning.

Like other filtering software, Connecture’s program is a multi-step search engine, screening out inappropriate options (based on your input) to deliver a manageable menu. After getting past the basics (Stripped-down “bronze” plan or high-benefit “platinum”? High deductible or low?), the program asks if it’s important to keep your current doctor.

“Based on our research, the choice of doctor was probably the No. 1 and No. 2 [features] of what people are looking for in a plan,” said Christopher Neuharth, Connecture’s director of user experience.

To try to reduce sticker shock, Connecture shows your net premium price — after the tax credits are applied — early in the shopping process. But perhaps the most important feature is the one estimating the total cost of coverage, including deductibles and co-pays, based on your reported health status. Without that information somebody with a chronic condition requiring lots of care could choose a plan based only on a low premium, not realizing the total expense could be substantially reduced by paying a larger premium up front.

“There’s all sorts of wild ways that carriers can design benefits to meet the actuarial value” required by the health law, Neuharth said. “You have to show the total cost of ownership.”

With three months until the exchanges open, the product isn’t finished. Connecture awaits tryouts by Minnesota, Maryland and┬áDC on specific demographic groups expected to apply for coverage. It could tweak the software based on their responses, Neuharth said.

Your exchange experience may vary. Connecture had a head start, launching work on the code shortly after the health law passed in 2010. Minnesota, Maryland and DC are far ahead of other states in developing their exchanges. At the same time, the best shopping site in the world won’t delight consumers if products are sparse or subpar.

Thanks to the “narrow network” strategy pursued by many insurers, your preferred doctor may not show up in any of the plans on offer. On the other hand, narrow networks are expected to be less expensive because they seek discounts from select doctors and hospitals in return for patient volume. Sorting out such pluses and minuses to help consumers make informed choices is the software’s job.

4 Responses to “Test Driving The Obamacare Software”

  1. Julie says:

    This is all nice but once again it does not help people that are computer illiterate, or don’t have a computer. Access to the Health Exchanges is all based on the assumption that everyone has a computer, or access to electricity for that matter. Has anyone asked about the homeless? What about the people that can’t read??

    They don’t let you ” test dirve” cars if you don’t know how to drive, how can you “test drive” Health Care Exchanges if you don’t know how to work a computer??

  2. Kay says:

    I understand your point, Julie. The reality is, we have become a web-based society. It is also important that large numbers of young, healthy people enroll through the Exchanges. Having sophisticated web platforms may aid that.

    There will also be state-based and national call centers to help enroll people. Additionally, community providers may be used in some states (like MD) to assist people with enrollment face-to-face much like they currently assist people with getting enrolled in Medicaid and other social programs.

    I am very concerned about testing of these web-based systems, however. I hope they can get all the kinks ironed out quickly — because there will be kinks.

  3. Maxwell says:

    I’m always an advocate for making things more accessible, but just to be clear – homeless folks won’t qualify for a subsidy on the exchanges unless they are homeless and also make $12,000/yr. In states that do expand Medicaid, these folks will qualify. In states that don’t, they likely won’t qualify for the exchanges because they won’t make more than 100% of the federal poverty level. I think it’s still important to think about lower-income people (100%-200% FPL) who will qualify for subsidies and might not have computer access. The phone and in-person assistance is supposed to help those folks and I think questions about whether these systems will be ready and well-funded are totally relevant.

  4. Gordon says:

    I have never lived in a place in the US in the last 15 years that didn’t have public libraries with free internet access. I think the access argument is a non-issue. The computer literacy argument may be more relevant, but I’d wager almost everyone knows someone knowledgeable they’d feel comfortable asking for some assistance with a computer.

    The biggest issue, I think, is the fact that lots of people won’t even know they are supposed to go on the exchanges, or that the option is there. The publicity needs to ramp up. I should be seeing ads everywhere about the coming exchanges, but I don’t think I’ve seen a single one.