Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Earlier today, I saw something on my computer that I had never seen before. And, for me (and a few of my colleagues) it was quite exciting. It was this screen:
After two weeks of trying, I was able to successfully apply for coverage on HealthCare.gov. After spending the morning tooling around the site, here's what I've taken away from it.
1. The site is moving faster but not at full speed. Going through the application process, I quickly became familiar with this screen.
Between most steps in the application, whether it was informing the government about where I live, whether I was a member of a Native American tribe or seeing my insurance options, this "please wait" box would pop up. Usually it would stick around for about 15 seconds or so. This was a bit of a bump in the process, but by no means a fatal delay.
2. Applying for coverage without subsidies is way easier than seeking financial help. I tried filling out two applications, one that asked the federal government for financial help and a second one that did not. The first application took a lot longer to fill out; the federal government needed a significant amount of information about how much I earn, who is in my family and whether my employer offers coverage. I spent about 30 minutes working on those forms and, now that they're done, my application is labeled "in progress." No word on when it will be deemed complete, and allow the shopping process to begin.
Applying without help from the government, by contract, was a breeze. There were about five minutes between starting the application and seeing my plan options, a good deal of which was spent staring at the above "please wait" screen.
3. In Virginia, premiums really vary. When I first got to the shopping screen, I saw that premiums for catastrophic plans ranged from $128.54 to $1,370. That latter price really surprised me: over $1,000 per month for the least-robust plan?
Innovation Health is indeed listed as offering a catastrophic plan with a deductible of $6,350 for over $1,000 each month. Turns out, this is due to a quirk of Virginia law, which requires insurance plans to offer a product that covers bariatric surgery as an obesity treatment. Since the surgery is pricey, that explains the hefty premium. Innovation Health also has a much less expensive plan that leaves out the treatment.
4. Shopping is pretty easy! Logging into HealthCare.gov, as many Americans have learned since Oct. 1, is hard. One reporter has logged over 60 attempts to sign in, and still has yet to succeed. Another man I talked to in Indiana today has filled out three separate applications and called two different navigator groups - both of which told him they wouldn't be certified to perform enrollments for another two weeks.
The Web site, in short, still doesn't work for a lot of people and the launch, by most accounts, has not gone smoothly.
The shopping experience is, by contrast, pretty easy to use. In Virginia, for example, there are 36 health plans. You can sort them by the level of coverage they offer, the premium price, the deductible and a few other options. Three plans can be compared side-by-side at the same time.
This is the part of the health shopping experience that is supposed to be like Kayak, with different options lined up side-by-side. Below the information on premium and deductibles is on everything from the cost of prescription drugs (both generic and brand name), to whether a regular hearing exam is included and to the average total cost for delivering a baby.
All of that still doesn't matter, though, if people can't make it onto the Web site in the first place.
KLIFF NOTES: Top health policy reads from around the Web.
In states that don't expand Medicaid, over 5 million will be left out of the coverage expansion. "About 5.2 million poor, uninsured adults will fall into the “coverage gap,” created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a study released today by the Kaiser Family Foundation. These people are projected to have incomes too high to qualify for their state’s existing Medicaid programs, but below the federal poverty level (nearly $11,500 for an individual) required to be eligible for federal subsidies to buy private coverage on the new online insurance marketplaces set up by the Affordable Care Act. Medicaid is the state-federal health insurance program for the poor." Phil Galewitz in Kaiser Health News.
Hawaii's marketplace has finally opened, two weeks late. "Hawaii's health insurance marketplace under President Barack Obama's federal health care overhaul began offering plans for sale on Tuesday, more than two weeks after the start of open enrollment. Hawaii Health Connector Executive Director Coral Andrews said at a news conference that consumers can now review and buy plans offered on the exchange's website." Oskar Garica in the Associated Press.
Visits to HealthCare.gov have fallen by 88 percent. "Of the 9.4 million unique visitors to the site during the first week, roughly a third attempted to register and 1.01 million completed registration, according to the analysis. Millward Brown Digital — which tracks the online activity of 2 million Americans, or 1 percent of all Internet users in the United States — said that roughly 36,000 Americans signed up for an insurance plan online the first week." Juliet Eiplerin in the Washington Post.