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."