Wednesday, November 26, 2014
Inquirer Daily News

Let's improve care website

The HealthCare.gov website as it appeared on March 31, 2014, the end of the first open enrollment period. In a commentary, three professors write about their University of Pennsylvania study of how young adults would change the site. (AP Photo/J. David Ake)
The HealthCare.gov website as it appeared on March 31, 2014, the end of the first open enrollment period. In a commentary, three professors write about their University of Pennsylvania study of how young adults would change the site. (AP Photo/J. David Ake)

'Calling insurance catastrophic is like a fear tactic, and I don't think people should be scared into health care. ... Couldn't they call it something else?" said a 27-year-old uninsured Philadelphian after she shopped for a health-insurance plan on Healthcare.gov.

It's easy to criticize any new effort. Healthcare.gov received its share of criticism, some based on partisan debate over the Affordable Care Act (ACA) and some based on its technical failures. But as young adults in Philadelphia navigated the options on Healthcare.gov, they recognized a fundamental challenge to selecting a plan: Health insurance is complicated, and we need a better way to make it understandable.

The young adults, from 19 to 30 years old, were participating in a University of Pennsylvania study, being released today, done in partnership with Young Involved Philadelphia, a civic engagement group. We focused on young adults' user experience with the exchanges. They may be the hardest to recruit to sign up for health insurance, but once on Healthcare.gov, young adults were invaluable in recommending ways to improve the platform. Growing up with the Internet, in the online shopping and rating era, gives them a huge advantage in thinking about ways to make Healthcare.gov better.

For example, young adults asked for better explanations of terms, like deductible or coinsurance. If you don't know what a deductible is, it's hard to make a good choice about health insurance, no matter how motivated you are. They pointed to online programs such as Turbo Tax as models in which easy-to-understand definitions and examples appear when you hover your cursor over an important term.

They also said that it was difficult to determine if particular benefits - like affordable preventive care - were covered in the plans on Healthcare.gov. As it turns out, preventive care is provided at no additional cost in all marketplace plans because it's considered an essential health benefit under the ACA. They were looking for something that was already in every plan but was strangely invisible. The Philly young adults wanted to see these benefits up front when clicking on each plan's details.

But don't drown them with choices and information, because the process can be overwhelming. As one 29-year-old Philadelphian said, "I feel like I'm just kind of shooting around in the dark." Instead, let them narrow their searches using check boxes for important insurance features or sliding-bar ranges for prices they're willing to pay, just like they do when shopping on most other websites.

The young adults' recommendations remind us that it takes more than technical fixes to make Healthcare.gov work well. And policy makers in Washington have a great opportunity to improve and redesign the system before the next open enrollment period in November.

Don't let selecting a health-insurance plan become a catastrophe in itself. Use these local suggestions to improve the process for people of all ages, and all over the country.

 


Dr. Charlene A. Wong is a pediatrician in the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania. charwong@upenn.edu

Dr. David A. Asch is professor at the Perelman School of Medicine and the Wharton School at Penn, and and a physician at the Philadelphia VA Medical Center. asch@wharton.upenn.edu

Dr. Raina M. Merchant is an assistant professor in the Department of Emergency Medicine at the Perelman School.

raina.merchant@uphs.upenn.edu

Charlene A. Wong, David A. Asch, and Raina M. Merchant
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