One of the obvious problems with the current version of the Patient Protection and Affordable Care Act (PPACA) public exchange system is that it turns respectable, well-meaning government officials into hucksters.
Public agencies and consumer groups that would normally be flooding the Internet with press release and comment letters complaining about genuine, painful (but hard to fix) problems with commercial health coverage instead flood the Web with press releases, blog entries and tweets urging consumers to buy…coverage that might not be that great for them.
Maybe some young, healthy consumers would really be better off going through medical underwriting and getting temporary health insurance. Many high-income people at all income levels would be wise to compare off-exchange, PPACA-compliant major medical policies with the exchange qualified health plans (QHPs).
But are regulators in the states with state-based exchanges doing much to speak up for the idea of looking at off-exchange and non-PPACA options? Not as far as I can see.
Similarly: Exchange managers are talking a lot about the idea that consumers should visit their states’ public exchange enrollment sites during the second annual PPACA major medical open enrollment period, rather than simply letting their coverage renew automatically, and look to see if they could cut their premiums by switching exchange QHPs.
It seems as if the officials making these statements usually squeeze in half a phrase about “finding a plan that meets your needs,” but the dominant message is, “Cut your monthly premiums! Who cares about anything else, bozos!”
Officials in the U.S. Department of Health and Human Services by proposing that HHS automatically shift consumers who fail to make a conscious plan renewal choice into the cheapest plan in a given metal level.
On the one hand, saving money on health insurance premiums is a fine idea.
On the other hand: Buying insurance based solely on the premiums is not a strategy that any sensible consumer wants to use. Premiums matter, but so do deductibles, co-payments, coinsurance levels, call center responsiveness, claims administration, provider network performance and whether or not one’s own favorite providers are in the network.
PPACA exchanges are supposed to provide plan quality information, but, in practice, the only quality and value indicators public exchange shoppers get from the exchange sites is information about whether their providers are in the plan provider directories, and, possibly, whether the plan covers some routine sick care visits or condition management extras before enrollees meet their deductibles.
In most of the country, exchange program managers have done their best to squeeze the people who fight raw premium-based spreadsheeting — traditional agents and brokers — out of the health consumer advisory game.
On the third hand, of course, “fighting spreadsheeting” can be a euphemism for “selling the customer bells, whistles and marketing fluff to jack up rep compensation.”
But, on the fourth hand, given that, in this situation, the public exchange consumers are supposed to be relatively unsophisticated people, and that they have such little information about exchange plan quality to start with, it seems to be particularly horrible to encourage them to think that all that matters about a health plan is its price.
On the fifth hand, encouraging consumers to think hard about plan quality as well as a price is a way to get consumers to look to see whether the new PPACA system is encouraging insurers to “hollow out” coverage — to sell the skimpiest possible plans that meet the letter of the law in the PPACA coverage requirements.
Thinking hard about quality might help consumers see whether they’re getting comprehensive, catastrophe-preventing coverage, or an expensive PDF that offers a lot of useless digital hot air. Maybe the public exchange program managers don’t really want to encourage consumers to do that.