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Lessons Learned For 2015 From This Year's Obamacare Sign-Ups

Apr 9, 2014
Originally published on April 9, 2014 9:32 am

President Obama was thrilled last week when he was able to announce that more than 7 million people have signed up for insurance under the Affordable Care Act.

"This law is doing what it's supposed to do," the president said in the Rose Garden. "It's working."

But that's not to say it couldn't work better. Among those suggesting ways to help is the consumer group Families USA. The group's got a list of 10 specific changes it says could improve outreach and make the overall process easier for people to navigate.

Perhaps the best thing about this particular list, is that "none of these recommendations require legislation from the Congress," said Ron Pollack, the group's executive director. "These changes can either be implemented by the Department of Health and Human Services or state marketplaces."

Less Reliance On Websites, More Face-To-Face Chats

Pollack's group proposes, for example, more funding for navigators and other people who can provide in-person, individual counseling to help people select and sign up for health plans, along with more education about the availability of financial support to help offset the cost of monthly premiums.

Another proposal, which has come in various versions, would create a special new enrollment period right around the time people are filing their taxes. Rachel Klein, who co-authored the report for Families USA, says that option would be particularly important for people who are still uninsured at tax time next year.

"There are a number of people who will find they are subject to a penalty because they did not have insurance in 2014," she said on a conference call with reporters. "Those people will have missed the open enrollment opportunity for coverage in 2015 and thus they will be subject to two penalties."

A Special Tax-Time Open Enrollment Period?

In other words they will owe one penalty for not having coverage in 2014, and another because they missed the 2015 open season, so they will remain uninsured for that year, too. Allowing people to purchase coverage for 2015 at that point could help minimize some of what is sure to be a backlash against the law next spring.

Others have recommended that going forward, the general open enrollment period should be shifted from the autumn to instead coincide more with tax season. For one thing, that's when people who are uninsured may be likelier to have extra money to put toward health insurance.

For another, says Klein, "that will also enable tax preparers to play a much more significant role in helping people to understand their coverage options and helping them get signed up."

Meanwhile, others remain concerned that choosing a health plan simply remains much too difficult a task for the average consumer.

"People can't figure [it] out: 'Is a $200 deductible and a $10,000 out-of-pocket limit better for me than a $2,000 deductible and a $3,000 out-of-pocket limit?' " says Robert Krughoff. He heads Consumers' Checkbook, a nonprofit based in Washington, D.C., that publishes ratings of a wide array of services, including health care. "And taking into account coinsurance and copayments and all those things, people just can't do it," he says. "Ph.D. economists can't do it."

Online Tool For Better Comparisons of Health Plan Options And Costs

Consumer's Checkbook has for 35 years published a guide to help federal workers choose from the dozens of health insurance options available to them each year. So Krughoff and colleagues decided to see if they could do something similar for the health exchanges. The first thing they realized, he says, is that too many people are choosing plans based on premiums alone.

"They would look at a premium that looks like it's going to save them $1,500 a year [and think] 'Great!' " he says. But after doing more precise estimates, "it turns out that plan will cost them $2,500 more a year than some other plans. They really shouldn't do it on premium alone."

Nor should people choose plans based on deductibles, or even "metal levels" — gold, silver or bronze, he says. Those, too, provide misleading results.

Instead, Krughoff and his staff built an online tool that lets people estimate all health their costs (in a good or a bad year) in about five minutes by answering a few questions — about their health status, family and income demographics, and about any anticipated health spending. They can also plug in the names of their doctors.

So far their program has only been up and running in Illinois. But Jillian Phillips, a healthcare navigator with the Campaign for Better Healthcare in Chicago, said she used the tool this year and likes it a lot.

"It was really helpful because it saved me a lot of time," she says, "versus having to crunch all the numbers and show them what it would add up to be."

Krughoff says it would be cost-prohibitive for his group to try to replicate the tool for all 50 states, or even for the 36 states in the federal exchange. But he hopes the federal government might step in to help make sure people don't land in plans that aren't necessarily the right fit.

Too much attention has been focused on delays in getting signed up, he says, and not enough attention on making sure each family gets into the right plan. Having to wait an extra two weeks to get insurance "might be catastrophic for some people," he says. "But paying $2,000 more for your insurance than you need to — that could be pretty catastrophic, too. And there hasn't been enough emphasis on that."

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DAVID GREENE, HOST:

This is MORNING EDITION from NPR News. Good morning, I'm David Greene.

Well, after months of political back and forth, website malfunctions, deadlines and delays, the last few people are now signing up for coverage under the Affordable Care Act, at least for this year. Health advocates are already looking ahead to the open enrollment period for 2015, which starts in the fall.

And NPR's Julie Rovner reports there are plenty of ideas out there to make the process work better next time.

JULIE ROVNER, BYLINE: President Obama took what amounted to a victory lap last week, when it became clear that more than seven million people managed to sign up for health insurance during the health law's first official open season.

(APPLAUSE)

PRESIDENT BARACK OBAMA: All told, because of this law, millions of our fellow citizens know the economic security of health insurance, who didn't just a few years ago, and that's something to be proud of.

ROVNER: But that's not to say the enrollment process couldn't use some improvement. Among those suggesting ways to help is the consumer group Families USA. It's got a list of 10 specific changes it says could improve outreach and make the overall process easier for people to navigate. Perhaps the best thing about this particular list, says Ron Pollack, the group's executive director...

RON POLLACK: None of these recommendations require legislation from the Congress.

ROVNER: Among the group's proposals are more funding for navigators and other people who can provide in-person individual counseling to help people select and sign up for health plans, along with more education about the availability of financial help for people to pay premiums.

Another proposal has come in various versions. It would create a special new enrollment period right around the time people are filing their taxes. Families USA's Rachel Klein says that would be particularly important for people who are still uninsured at tax time next year.

RACHEL KLEIN: There are a number of people who will find they are subject to a penalty because they did not have insurance in 2014. Those people will have missed the open enroll opportunity for coverage in 2015, and thus they will be subject to two penalties.

ROVNER: One penalty for not having coverage in 2014 and another because they missed the 2015 open season, so they will remain uninsured for that year too. Allowing people to purchase coverage for 2015 at that point could help minimize some of what's sure to be a backlash against the law next spring. Others have recommended that going forward open enrollment should be set to coincide more with tax season. For one thing, that's when most people who are uninsured have extra money to put towards health insurance. For another, says Klein...

KLEIN: That will also enable tax preparers to play a much more significant role in helping people understand their coverage options and helping them get signed up.

ROVNER: Meanwhile, others remain concerned that choosing a health plan simply remains much too difficult a task for the average consumer. Robert Krughoff heads Consumers Checkbook, a Washington D.C.-based nonprofit that publishes ratings on a wide array of services, including health care.

ROBERT KRUGHOFF: People can't figure out is a $200 deductible and a $10,000 out-of-pocket limit better for me than a $2,000 deductible and a $3,000 out-of-pocket limit, and taking into account co-insurance and co-payments and all those things, people just can't do that. Ph.D. economists can't do it.

ROVNER: Consumer Checkbook has for 35 years published a guide to help federal workers choose from the dozens of health insurance options available to them each year. So they decided to see if they could do something similar for the health exchanges. The first thing they realized, he said, is that too many people are choosing plans based on premiums alone.

KRUGHOFF: They would look at a premium that looks like it's going to save them $1500 a year - real great. You run it through, the estimates of out-of-pocket costs, et cetera, and it turns out that plan will cost them $2500 more a year than some other plans. They really shouldn't do it on premium alone.

ROVNER: Comparing deductibles or even metal levels - gold, silver or bronze - gives similarly misleading results, Krughoff says. So he and his staff built a tool that lets people estimate all their health care costs, in a good or a bad year, and see if their doctors are in the plans too - all in about five minutes. So far it's only gotten up and running in Illinois.

But Jillian Phillips, a healthcare navigator with the Campaign for Better Healthcare in Chicago, said she used the tool this year and likes it a lot.

JILLIAN PHILLIPS: It was really helpful because, first of all, it saved me a lot of time, versus having to kind of crunch the numbers and show them what it would add up to be.

ROVNER: Krughoff says it would be cost-prohibitive for his group to try to replicate the tool for all 50 states, or even the 36 states in the federal exchange. But he hopes the federal government might step up and work with them to make sure people don't end up in plans that aren't necessarily the right fit.

Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.