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How Kentucky Built the Country's Best ACA Exchange
Hugh Pickens DOT Com writes "Dylan Scott writes at TPM that Kentucky, with its deeply conservative congressional delegation, seems like an unlikely place for Obamacare to find success. Instead, Kentucky's online health insurance exchange has proven to be one of the best, and shows that the marketplace concept can work in practice. Kentucky routinely ranks toward the bottom in overall health, and better health coverage is one step toward reversing that norm. It started with the commitment to build the state's own website rather than default to the federal version. On July 17, 2012, a few weeks after the U.S. Supreme Court upheld the Affordable Care Act, Democratic Gov. Steve Beshear created the exchange via executive order, over the objections of a Republican-controlled state legislature, which sought other means — including an effort to prevent the exchange from finding office space — to block the site's creation. ... Testing was undertaken throughout every step of the process, says Carrie Banahan, kynect's executive director, and it was crucial because it allowed state officials to identify problems early in the process. ... From a design standpoint, Kentucky made the conscious choice to stick to the basics, rather than seeking to blow users away with a state-of-the-art consumer interface. It 'doesn't have all the bells and whistles that other states tried to incorporate,' says Jennifer Tolbert. 'It's very straightforward in allowing consumers to browse plans without first creating an account.' A big part of that was knowing their demographics: A simpler site would make it easer to access for people without broadband Internet access, and the content was written at a sixth-grade reading level so it would be as easy to understand as possible."
To quote wikipedia.
"The study, the most comprehensive study of literacy ever commissioned by the U.S. government, was released in April 2002 and reapplied in 2003 giving trend data. It involved lengthy interviews of over 90,700 adults statistically balanced for age, gender, ethnicity, education level, and location (urban, suburban, or rural) in 12 states across the U.S. and was designed to represent the U.S. population as a whole. This government study showed that 21% to 23% of adult Americans were not "able to locate information in text", could not "make low-level inferences using printed materials", and were unable to "integrate easily identifiable pieces of information." Further, this study showed that 41% to 44% of U.S. adults in the lowest level on the literacy scale (literacy rate of 35 or below) were living in poverty.[2]
A follow-up study by the same group of researchers using a smaller database (19,714 interviewees) was released in 2006 that showed some upward movement of low end (basic and below to intermediate) in U.S. adult literacy levels and a decline in the full proficiency group.[3]"
The less literate seem likely to be over-represented in the users of these exchanges.
And they play a mean banjo too. I saw "Deliverance".
P.S. A widely used technique in American humor has long been to have an outwardly unsophisticated character who is actually more insightful than the superficially sophisticated characters. In the spirit of the Appalachian-American(1) stereotype, it looks like Kentucky has brought humor to real life.
(1) Bo Duke said that this term was now preferred to "hillbilly".
I think you are cutting the Republicans too much slack. The current crop of faux Republicans want to destroy trust in government. That way the voters will decide on less government. The Tea Baggers (and I include that Svengali, Grover Norquist) are even worse than that. They want to destroy the rest of the world's trust in the U.S. so that there will be no "foreign entanglements". Their belief is just the same as it was in the 1930's, that if the U.S. leaves the rest of the world alone, it will leave the U.S. alone. And that ended very badly.
You could get most of that by dropping the tax subsidy for employer insurance plans.
Eh, they just wanted the bar set so Rand Paul could understand the site. Mitch McConnell is SOL though.
Rand Paul graduated college and medical school, and passed certification of American Board of Ophthalmology — before running for Senate and winning.
I'd wager, his reading comprehension is above that of most people — yourself included.
McConnel has "only" a bachelor degree of formal education, but that's still well above most people... Whatever your beef with your political opponents, sneering at their education only makes you look ridiculous.
In Soviet Washington the swamp drains you.
This is actually a basic principle of what we today call iterative design, and back in days of yore called Worse is Better. Its not a new concept.
Rand Paul graduated college and medical school, and passed certification of American Board of Ophthalmology — before running for Senate and winning.
Rand Paul isn't board certified by the American Board of Ophthalmology--at least he hasn't been since 2005. Yes, he passed his board exam in 1995, but rather than recertify (like every other doctor has to), he opted to create his own "National Board of Ophthalmology" with himself as president. (see wikipedia if you don't believe me)
To be fair, it does take a certain amount of intelligence to give the middle finger to your accrediting board and create your own professional board "shell" company. Doesn't say much for his ethics or proficiency at ophthalmology. I guess that's why he went into politics, those traits likely serve him well.
"[T]he content was written at a sixth-grade reading level so it would be as easy to understand as possible."
They really are setting the bar high in Kentucky.
That's pretty standard for text intended for the general public. Newspapers have traditionally been aimed at a sixth-grade reading level too.
The cow says "Moo." The dog says "Woof." The Timothy says "Thanks, valued customer. We appreciate your input."
That is simply not true. Life expectancy. Infant mortality. Deaths from burns. Drownings. Deaths from falls. Deaths from poison.
Pick any metric that you like and you'll see similar results. The reality is that the U.S. paying FAR more than virtually all other countries for health care and getting demonstrably poorer results than many, including most of Europe. (We're tied with the Marshall Islands with Tuvalu and Niue close behind. Everyone else spends far less than we do.)
Worse, if you set any of the graphs in motion it becomes blatantly clear that for the past several years, we have been spending ever more on health care and seeing next to no improvment. It's most blatantly obvious in the case of infant mortality but the same trend is clear for virtually all variables. Meanwhile, country after country following more 'socialist' models are seeing far better results from the dollars that they spend.