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Health Works Collective > Policy & Law > Health Reform > What’s the Deal with the Exchanges?
BusinessHealth ReformPolicy & LawPublic Health

What’s the Deal with the Exchanges?

Greg Scandlen
Last updated: October 13, 2013 8:00 am
Greg Scandlen
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7 Min Read
obamacare health exchanges
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Whether it is a website or a retail store, good marketing requires focusing on the product you are trying to sell. You feature it in the window display, whether that is a physical window or a digital one.

If you are selling cars, you put the shiny new model in the window, with banners talking about the features your target market most desires ― comfort, speed, economy, sex appeal. You let people test drive it so they will fall in love with it.

Whether it is a website or a retail store, good marketing requires focusing on the product you are trying to sell. You feature it in the window display, whether that is a physical window or a digital one.

If you are selling cars, you put the shiny new model in the window, with banners talking about the features your target market most desires ― comfort, speed, economy, sex appeal. You let people test drive it so they will fall in love with it.

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If you are trying to sell health insurance, you promote the most popular features of the insurance and let the buyers browse around the different models until they find the one that is just right for them.

obamacare health exchangesThat’s how eHealthinsurance.com does it. They put very few obstacles between the buyer and the browsing. All you have to do is enter your zip code to find out what is available in your area and the world of choices opens up. You can see what the benefits and costs will be. Only after you have made your selection do you have to start filling out the paperwork.

That is not how the ObamaCare exchanges operate. You can’t see any actual insurance plans until you first fill out a whole lot of paperwork. Even Kentucky, the state with the best performance so far, requires you to complete a form including your name, address, phone number, and social security number, which must then be verified by “public records and consumer credit information.”

So, what is it they are selling? Apparently not health insurance or they wouldn’t make it so difficult to see what you might want to buy. No, what they are selling is dependency. The priority is to determine whether you will be eligible for a subsidy. All this information is required of everyone ― even the large number of people who aren’t interested in or qualified to receive a subsidy.

This is completely backwards. People are unlikely to go through all these applications until they have a pretty good idea of what it is they are applying for. It is like being expected to fill out an application for a car loan without having any idea of the cars that are available.

Plus, many of the web site visitors aren’t potential buyers at all. They may be reporters, or researchers, or just the public curious to see how its tax dollars are being spent. All are required to fill out the same forms before they can see any actual insurance products.

Once the paperwork is filled out, a whole bunch of extremely technical and complex transaction take place on the server. These are invisible to the user but IT experts are boggled by the complexity.

Reuters reports –

Five outside technology experts interviewed by Reuters, however, say they believe flaws in system architecture, not traffic alone, contributed to the problems.

For instance, when a user tries to create an account on HealthCare.gov, which serves insurance exchanges in 36 states, it prompts the computer to load an unusually large amount of files and software, overwhelming the browser, experts said.

If they are right, then just bringing more servers online, as officials say they are doing, will not fix the site.

“Adding capacity sounds great until you realize that if you didn’t design it right that won’t help,” said Bill Curtis, chief scientist at CAST, a software quality analysis firm, and director of the Consortium for IT Software Quality. “The architecture of the software may limit how much you can add on to it. I suspect they’ll have to reconfigure a lot of it.”

It adds –

One possible cause of the problems is that hitting “apply” on HealthCare.gov causes 92 separate files, plug-ins and other mammoth swarms of data to stream between the user’s computer and the servers powering the government website, said Matthew Hancock, an independent expert in website design.

Now, all of this might be much less of a problem if only serious buyers were subject to it ― people who had already found the product they wanted to buy and were now eager to get enrolled. As it is, it all applies to anyone who is curious about the products and prices being offered by the Exchanges.

It makes you wonder why the government wants to make it so hard to see those products and prices. I live in Pennsylvania and still don’t have the slightest idea which insurance companies are participating here, what benefits they are offering, or how much they are charging. For months now CMS has refused to disclose that sort of information, telling us to wait until the Exchanges are on-line. Now the Exchanges are up (supposedly), and we still can’t find out.

Welcome to the world of “the most transparent administration in history.”

TAGGED:health insurance exchangesHIEobamacare
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