Immediately following the Supreme Court's decision on the Affordable Care Act, the head of California's Health Benefit Exchange laid out his vision for revolutionizing the health insurance market.
"We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon," said Peter Lee, executive director of the California Health Benefit Exchange.
But as the state has worked to create the actual application for health insurance, the idea of a one-click purchase is far from the reality.
“This is a brand new law and it’s complicated,” says Sam Karp, vice president of programs at the California HealthCare Foundation (CHCF). “It’s reasonable to expect the implementation will take not just a year. It will take a few years.”
Karp says CHCF has been working on modernizing enrollment in health and social service programs for the last 15 years. Recently they partnered with others to create a model, called UX2014, that can be used as a standard for online health insurance enrollment.
The contract for California’s application was awarded to Accenture last summer. While a draft of the federal application was just released, stakeholders have yet to see a version of California’s application, which, like the federal model is being based on the UX2014 work.
The new federal draft application is 15 pages long for a 3-person family. A single applicant is only required to fill out 6 pages. Meanwhile a YouTube video shows what to expect from the online federal version:
Karp says after early promises that this would be like buying an airline ticket online, it’s important to set the right expectations.
“The law says we should have a consumer friendly process ... it should be better than what people are experiencing today and we should go to lots of lengths to make it easier for people,” Karp says.
The law requires the application be available online, in person, by mail or by telephone.
Karp says he has a few concerns about California's process so far.
"I’m concerned the premiums will be high and people will have sticker shock," says Karp. And he says unlike the federal system which will be a streamlined workflow, California will be integrating its application with some county websites and program.
"Service may not be as smooth as it could be because of this hand off to counties," says Karp.
Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, says she has been involved in some of the recent talks about the application flow. She says there are some aspects of the proposed California application she applauds.
"If you’ve gone through this whole process of applying for health benefits," she says, "you can have the information transferred to get other public benefits too – including CalWorks and Cal Fresh [food stamps]."
But she says she'll be keeping an eye on certain aspects of its development.
“The income is going to be especially tricky for people. People have different ideas about this. Certain income counts and certain other things don’t,” says Landsberg. “I think very few of us know what our adjusted gross income is. So there is going to have to be a lot of help and guidance to define these terms and give accurate information.”
Landsberg says she also thinks the proposed application organization requires a social security number too soon.
“We have a lot of families with mixed immigration status,” Landsberg says. “We may have a parent without a social security number applying for child who does have a social security number… You can’t require a non-applicant to give a social security and it might dissuade someone from moving forward.”
Landsberg says a draft of the California application is expected in April, to allow group testing in the spring and summer.
The application is due to go live online in October.