2018 MIDTERM ELECTION

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NY Times Double Play: CO-OP Sabotage & New HC.gov Tool Issues

Two big ACA-related stories in the New York Times this morning; each is worthy of a full entry, but I don't have time today so I'm lumping them together:

First up: The Times' editorial board has blasted the GOP over the CO-OP failure debacle. They give a concise summary of how the CO-OPs were created and why they're facing so many problems now:

[GOP critics] neglect to mention that the nonprofit plans, known as health insurance cooperatives, were created as a weak, underfunded alternative to a much stronger option that the Republicans blocked from passage.

...Their problems have been attributed to wrong estimates for how many people might enroll and to setting premiums too low to cover the cost of care, as well as severe reductions in the amount of money available to the co-ops from federal loans and for risk adjustment payments, both the result of Republican opposition to supporting the plans.

The overriding problem was the difficulty in setting up the co-ops from scratch to compete against entrenched insurance companies with deep pockets. Still, with capable management and adequate funding, nonprofit cooperative plans can succeed for patients and providers. Group Health Cooperative, based in Seattle, has been in business for 70 years. It provides coverage and care for around 600,000 people in Washington and Idaho.

Next, an update on some ongoing technical issues over at HealthCare.gov...not with the existing features, but with the brand-new "In Network" and "Total Cost" tools they announced a few weeks back:

With the Affordable Care Act’s third open enrollment period to begin in less than two weeks, federal officials are racing to fix new features of HealthCare.gov that are supposed to make it easy for consumers to find insurance plans that cover their doctors and prescription drugs.

The open enrollment period will start on schedule on Nov. 1, federal officials said Monday, but technology teams are still testing new features of the online marketplace with insurers. They have discovered many bugs, have fixed some and are still working on others, said insurers and federal health officials, who have already begun blaming each other for the problems.

Insurers said the government had not adequately tested the new search tools, which are still yielding incorrect search results in some dry runs. Administration officials said many insurers had still not submitted data on their health care providers and their drugs in the correct format.

Some insurers had expected HealthCare.gov’s “window shopping” feature to go live early this week, but because the tests are incomplete, consumers are not yet able to see the benefits, prices and other details of health insurance plans that will be offered for sale through the federal marketplace.

“We have extended the testing schedule to provide insurers with additional time to validate their data,” a Department of Health and Human Services official said by email. “We will launch window shopping closer to the launch of open enrollment.”

One of the new tools will allow consumers to search all health plans in their area for a specific doctor or hospital. Another tool will allow consumers to search health plans for a specific drug.

Consumers Union and other consumer groups said that these tools could be immensely useful to people shopping for insurance, but that the data must be reliable.

Collecting data from hundreds of health plans on tens of thousands of doctors, hospitals and drugs has proved immensely challenging, insurers and federal officials said. Under a new federal rule, insurers must submit their data to the government in a “machine readable” format. In theory, software developers can use such data to create tools that help consumers decide which health plan is best for them.

This is obviously a problem, but I'm not sure I understand why it's causing so much hand-wringing. As a website developer myself (obviously at a much less-complex level), if you have an existing website with various features that work properly and want to add new features, the obvious solution is to simply not enable those new features until they're working, while keeping the existing functions working as they already are.

Of course, it's possible that the system will only allow the "normal" window shopping to work with the new tools functioning as well; if that's the case--and that's what the story makes it sound like--then yeah, that's a serious issue. Hopefully they'll get this squared away ASAP...

The problem, of course, is that in a situation like this, not offering the features at all is better than offering them but having inaccurate data. If I'm shopping around and want to know whether my doctor is included in a plan's network, it's better for the website to tell me to contact the insurer (or doctor) directly than it would be for the site to say that they're "in network" when it turns out they aren't.​

UPDATE: Hmmm...according to this AP story on the same subject from yesterday, it sounds like the new tools are separate from the existing ones after all:

Lori Lodes, communications director for the agency that runs the health care program, said those online improvements will be ready to launch soon, but she would not commit to a specific date.

...Another consumer-friendly upgrade - a cost estimator - apparently won't be delayed.

The administration has set a goal of 10 million paying customers by the end of next year in the health law's insurance markets, which offer taxpayer-subsidized private plans to people who don't have access to job-based coverage.

By allowing a delay, the administration may spare itself some embarrassment if the promised online improvements had turned out to have bugs.