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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."
"[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.
Trolling is a art,
Kentucky did better than you did. One of the most ass-backwards hillbilly clueless groups of people around. And they beat you. Completely.
That's... Very very sad.
Well it seems those hillibillies really have the basics anchored down. Good for them.
Subject pun intended.
What is with all the websites which launch with a bunch of stupid bells and whistles? Just get the core functionality working, and then worry about the pretty pretty. Most sites never really make it that far, but they implement the gewgaws and glitter anyway.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
Something Bad is going to happen, because Obama called upon his Bottomless Well of Executive Power to delay the Employer Mandate unilaterally, fearing political fall-out for the 2014 elections should millions upon millions of previously-covered workers be dumped into the exchanges.
Will this happen? I don't know. But here's what I do know: Obama sufficiently feared this possibility to violate the Constitution and delay his own beloved pet boondoggle to avoid the possibility of it.
Right now we are talking about the millions and millions of people in the individual insurance market. They are getting screwed. But as a percentage of the country, this is a small number of people -- I think the fraction is something like 8% or so.
Caveat: I just made that up. But it's low.
We should be talking about What Happens Next. And critics of ObamaCare have some good authority to speak about What Happens Next, given that they already predicted What Already Happened.
The individual-market Losers are the canaries in the coalmine for tens of millions more likely losers.
I would like Obama and his Minions to be questioned closely about what they predict will happen next. I want them on the record as to their new promises about "if you like your plan, you can keep your plan" as regards employer-paid coverage.
Let's face it: If 90% of the country thinks, probably wrongly, that only 10% of the country is getting screwed, they will probably just shrug it off and say "Sucks to be them." All of these anecdotes about people getting screwed will not move the general public.
Only worries about What Comes Next, regarding themselves, will agitate them for the 2014 elections.
Honestly I don't know if the disruption in the employer markets will be as bad. I think it will be bad, but not as bad -- for one thing, I think employer-provided insurance already includes a bit of subsidization for sick workers-- in as much as the employer buys coverage for an undefined group, which might include very sick people -- the risks then are already pooled, at least to some extent. But only to some extent, because the sickest of all people probably do not work, and thus do not ever enter the employer coverage pools.
Employer coverage is also generally decent, and thus won't be much affected by increased demands for coverage. But it will be affected somewhat, and when ObamaCare demands that a business give its employees, effectively, a $1,000 or $3,000 annual raise in the form of a health care policy that covers previously uncovered things (and also steals money to subsidize the uninsurable), many companies may balk and simply stop providing insurance altogether.
Maybe this is the secret evil genius of Obama's plan -- he will get all those healthy people subsidizing the sick on the individual markets, because when his employer mandates start kicking in, many companies will dump their huge numbers of relatively low-risk people (remember, the most sick people can't actually work for a living) into the high-risk individual market pools.
Do I know these things? No, I don't. But after having not looked into these matters for five years straight, perhaps our media could trouble itself to rise from its lazy slumbers for a few minutes to begin asking some questions about ObamaCare.
Until now they've gotten everything about ObamaCare wrong. Can they attempt to get some of it right, before the employer mandate kicks in?
In effect the deliberately obstructionist Republican governors put the entire project at risk, and now the Republicans are screaming that it doesn't work. They are sick manipulative bastards who will do anything to get their way.
By the way, a friend of mine just signed up through the California exchange, and it was not a big deal. If the people in charge want it to work, they can make it work. If they want it to fail, they can make it fail. The Republicans want government to fail, so it does. By analogy, it's like going to a doctor who thinks medicine is bunk, and he proves it by having his patients die. In both a literal and figurative sense, Republicans are happy to see Americans die.
Why is Snark Required?
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Yup, it's the success of the governor, not the senators.
And Obama could do with having a look at what they did when they said "Fuck it, these idiots 'DO NOT WANT' to do anything where a Democrat, especially a half-black one, may get plaudits".
The summary does not explain that at all.
Nada: You see, I take these glasses off, she looks like a regular person, doesn't she? Put 'em back on...
[puts them back on]
Nada: ...formaldehyde-face!
##
Bearded Man: We could be pets, we could be food, but all we really are is livestock.
After seeing this headline on slashdot, I decided to look at the KY ACA website. It is terrible. Their website has navigation "glitches" where hitting the "back" button will not actually go back and will reload the same page.
They succeeded because the governor accepted a system that doesn't do it all, but gets right what it does. That is totally bass ackwards from how government normally does it in the US. It's pretty normal for 1.0 to be just about everything and the kitchen sink, not a modest product that's well-tested and positioned for rapid iteration through point releases to address bugs the full user base finds and new features.
21,000 out of the 26,000 who signed up in KY are enrolling in Medicaid.
All websites must be designed for use by rural Kentuckians.
Last post!
Are there any major features the federal site has to cover that these functional state-specific sites aren't handling? It depends on how fundamental the problems with the federal site are, but it seems like it might make sense to just take one of the better state exchange sites and add in whatever extra things are necessary for the federal site.
Obama admin. knew millions could not keep their health insurance
http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance?lite
Report: Obama administration knew millions wouldn't be able to keep insurance
http://news.yahoo.com/obama-administration-knew-millions-wouldn-t-be-able-to-keep-insurance--report-222249311.html
White House knew as early as 2010 millions would lose health plans under ObamaCare
http://www.foxnews.com/politics/2013/10/29/white-house-knew-as-early-as-2010-millions-would-lose-health-plans-under/
All websites must be designed for use by rural Kentuckians.
But Fark.com still sucks.
you 4ave a play
So the gist of the story is that a more conservative state that applied true free market ideas fared better than the ones that went with the usual big goverment ideas? Why am I NOT surprised? It is amazing to me that when you see SO much evidence that the free market is infinitely better than goverment that so many statists still claim otherwise.
A point I've read in The Economist, and has really stuck with me, is how one of America's strengths is the somewhat loose federation of the states, which allows for different approaches to any given problem. Each state can try its own approach to the ACA, or education, or taxation laws, et cetera. Eventually the "better" approaches should become clear, and the country as a whole will adopt them.
Now in practice it doesn't always work like that, but I think we see it in action right now with marijuana legalization and gay marriage.
Of course, the federation also means that, in cases where the "best" approach is known a priori, we lose efficiency when some states fail to adopt it. I don't consider that a big problem, because I think politicians are rarely capable of identifying and engendering quality programs right from the start, especially at the national level.
Let's hope the rule proves true here, and that other states copy Kentucky. (Maybe Kentucky can even share the code?)
I found it amazingly ironic that the states which take the hardest stance on wanting to do everything their own way because the federal government can't possibly know the nuances of their state needs nearly all chose to let the feds make the ACA website for them.
Is it just my observation, or are there way too many stupid people in the world?
weeks after the U.S. Supreme Court upheld the Affordable Care Act, Democratic Gov. Steve Beshear
There's your answer right there.
If something *can* be described in sixth grader terminology, why use harder terminology to explain it?
Testing and feature prioritization, how innovative! I am actually not being sarcastic. So many big projects push testing off as a "waste of resources" and absolutely don't prioritize features. For instance I don't know how many government web sites have a "Message from the ...(fill in organization head)" front and center of the front page of the website. I am willing to bet that less than 1% of people actually click on that. Then after that you often find news about awards and other ribbon cutting crap that the leaders feature in. And hidden away in the corners are the stuff that people actually want.
So with so many projects you have too many cooks who have their own internal priorities and the result is the wonderful British expression, A Dog's Breakfast.
Because I'm on my fourth online application and kynect had me in some sort of infinite loop purgatory (in which I wasn't allowed to complete the application process) for the past three weeks. This morning, I finally got a message asking me to upload additional documentation.
For what it's worth, the Cabinet for Health and Family Services is in charge of Kentucky's exchange. The same Cabinet which is responsible for child welfare and has a history of hiding information about child fatalities which occur under their watch.
Sent from my iPhone
Let's see, too many NON-PROTECTED CLASS individuals, too many FIREARMS, too much ALCOHOL, too much CHRISTIANITY, too many HORSES and PICKUP TRUCKS, too much PATRIOTISM, too many HOODS and SHEETS, too many BURNING CROSSES, too much ENGLISH LANGUAGE.
Behold the flip side, too few ASIANS, too little EASTERN PHILOSOPHY, too little GOVERNMENTAL PATERNALISM, too little POST-SECONDARY EDUCATION, too little DIE-VERSITY, too few FOURTEENTH AMENDMENT HUMANOIDS, too few SMELLY WHITE PEOPLE WITH NOSERINGS®.
I regret that the cesspool has not been agitated unto actionable effect, damn it!
I'm appalled that the overwhelming majority of the comments have mostly been cheap shots of the "hurr durr, dum hillbillies cain't reed, they need to dumb down the site".
The takeaway should be the that the KY developers properly understood that they need to make the site as widely accessible as possible.
the preceding comment is my own and in no way reflects the opinion of the Joint Chiefs of Staff
A successful Obamacare website won't matter in the long run. The purposes of Obamacare are to 1) destroy the private health insurance industry 2) force everyone onto a Medicaid-like system 3) become a general-purpose political weapon to control people's behavior and to suppress political dissent 4) drive the US into bankruptcy. Nationalized healthcare systems are driving European countries into insolvency even though US citizens have been paying for Europe's security, propping up Europe's standard of living and paying for the medical innovation that has improved healthcare around the world. If the US nationalizes its healthcare system, no country will prop up the US like the US has propped up Europe and dark days will be ahead for pretty much everyone on Earth.
Let's say we did switch to full socialism single payer healthcare. All the hospitals have already invested bazillions in equipment and have to make money to pay it off. How long would it take to start seeing the effects?
US about to be the world's biggest oil exporter.
NSA shutting down foreign surveillance while maintaining domestic surveillance
Kentucky is a model for a government-run IT project done right
Did Hell freeze over or something?
Did you think your former insurer would send you an offer for the best possible deal? Or did you think they'd try to get you to buy the most expensive thing they've got just in case you don't bother to check for alternatives?
1. Kiss my ass (D-->R)
2. How much do you have in your wallet? Send it in.
3. Omerta (code of silence, kiss of death for talkers)
They believed in a Republican presidency, so they prepared everything for the arrival of Romneycare. And apart from the nickname change and the Republicans disowning it, it actually arrived.
And this is why it works. Sounds like there were some actual proper software engineers involved in this and not just web "ooh, shiny!" developers.
What Kentucky is doing is expanding Medicaid enrollment. Very few are buying. So, you can look forward to more tax increases on those who actually produce to pay for more parasites. Greece and Portugal aren't really that bad. Why shouldn't the U.S. be just like them?
Either way, it all ends the same.
Why the hell do we have a news story about website design? The GOP are making a big political issue out of it, but I don't see that being much of a problem to anybody. Plenty of people have signed-up, and those that haven't probably weren't stopped by site problems, but just chose not to.
What will make or break Obamacare is the PRICE of the insurance plans, and nothing says Kentucky's prices are any lower than if they'd just let the Fed do, or any of the several other states with their own ACA website.
Personally, I was happy with my high deductible "catastrophic" plan for $70/month. Now ACA says nobody over 30 is allowed to chose that option, and even if you were, it has doubled in price. Now the lowest-priced health insurance plan I can get is 3X what I was paying, and is only slightly better than what I had before.
That is what will make or break Obamacare... Will healthy, middle-class folks pay hundreds of dollars per month for health insurance they are unlikely to use (on top of already paying out 1/3rd of their income in state/federal taxes), to subsidize the insurance prices for unhealthy and lower-income people?
And will the working poor, who are just barely able to make it paycheck-to-paycheck, find a way to muster up another $100/month to pay for their health insurance? Or will the tax penalty at the end of the year eat up their refund and really make their precarious situations completely untenable?
Failing to take one step further and making it a simple, automatic, single-payer system, supported out of income taxes, really is a mistake we'll be paying for, for a long time to come.
Slashdot gets worse every day... Pipedot: News for nerds, without the corporate slant
Here's a shocking idea... why didn't we do this through the states in the first place!?
All the states that want it... get it. All the states that don't... don't.
Democracy. Instead... we have this...
I've decided to stop wasting my time responding to AC trolls/sockpuppets... so if you want a response from me... login.
They must still have a few old geezers from Bullit County who are smart enough to get it done.
Joking aside, it's a *fast* web site; but you sill have to enable scripting. It's a bit of a "wall of text" which is surprising to me. Also, like all the exchanges I've seen so far, including California's, it's got those stupid social networking buttons on it. To Kentucky's credit, at least they're tucked way down at the bottom. Why, oh why do we need a friggin YouTube button on such a site??? WTF, really? You're gonna FaceBook a link to the page where you signed up, which shouldn't populate with data anyway. Please tell me it doesn't transmit all the form fields if you press the social networking buttons...
For all intensive purposes, "whom" is no longer a word. That begs the question, "who cares"?
I'm curious.
Gee, isn't that the lesson of Google's initial success? Keep it simple and clean. No need for eye candy and extra bells and whistles. They add bugs and detract from the purpose of the site. As time has gone on, Google has drifted away from this concept, but the KISS principle remains valid and clearly had worked well for Kentucky.
Web sites, especially those with a single purpose, don't need 7 fonts, cool graphics, Flash flash, Java, or even CSS. Not that any of these (excepting Flash flash) are bad, but too many web designers seem to think that they are mandatory. The cost in development times, reliability, and ease of use is only justified by ego of developers and their managers. The purpose of the site is to provide important information and not to make health insurance look sexy!
Kevin Oberman, Network Engineer, Retired
I worked as a developer in electronic healthcare for a bit. I got out quite soon.
A quick example, when people started talking about electronic medical records, their eyes light up and it turns to databases of information, classification of everything, optimizing treatments and data... MORE DATA... MORE DATA
In reality, the first use case for medical records that most people and physicians see is just being able to see the healthcare records. If a patient shows up at a walk-in clinic at another provider, the doctor there is able to pull up the record.
Something as simple as just being able to store the scanned copies of documents and test results would have been an amazing first step. You don't need a very high resolution copy. I know the storage equation might be an issue, but they don't really write essays. From there, they could move on to more standardization of others...
I'm glad Kentucky kept it simple. It really is the best way to get something going out of a complex system.
if the main problem with the federal exchange site is a lack of load tolerance, then start by *reducing the load*. Assign sign-on days by birth month, birth year or SSN prefix. Alternatively, create draft lotteries and designate sign-on days based on the "draft" number. This is the government after-all; it's not like people are going to run off and find another web site.
https://kyenroll.ky.gov/PreScreening/IndividualCalculator
select Out of State from the drop down with 400k , 40 , 3 for income , age and family members
An error has occurred while processing your request. Please contact Customer Service at 1-855-4kynect (459-6328) TTY: 1-855-326-4654 Customer Service is available Monday – Friday, 8 A.M. to 7 P.M. Saturday hours vary. While contacting customer service, please provide this number CHFS93675967 for reference. We are sorry for the inconvenience.
Also -- back button is disabled.
"I'm all in favor of chicks doing birth control, but personally, the pill isn't gonna do me any good. Why should that be on MY policy?"
1. Chicks hate it when you call them Chicks. The "doing birth control" doesn't make you sound like a winner either....
2. Are you planning on having sex sometime? Then the Pill is indeed going to do you some good. I'll give you a tip (phrasing!)... Your chances of having sex will go up if you don't spout this stupid crap in front of women.
3. The whole point of insurance is to minimize risk. Everyone pays a little bit, and the money is doled out to the few that need it. You're not paying FOR YOU. You're paying a little bit for EVERONE, and getting covered just in case something bad happens to you.
3 again. Just in case you didn't get that. With insurance, you're not paying for healthcare. You're paying for reduced risk.
50% of humans are women (Not "chicks"), and we all benefit from them being able to have sex without worrying about pregnancy. So stop being an ass, shut up, and go get laid. And seriously, lose the attitude, it'll help.
It's easy....the problem with the federal site is that everything is bigger. They have to handle the user load from all of the states that decided not to do their own thing. They have to maintain connectivity and exchange data with the insurance companies and plans for every one of those states. They have to interface with their own back-end systems for subsidy eligibility and everything else for all of those states. None of that is easy to coordinate or implement. In Kentucky, you have a total population of less than 5 million and according to the state, less than 700k are uninsured. (http://insurance.ky.gov/Static_Info.aspx?Static_ID=119&Div_id=16). That's not a huge number of potential hits. A large percentage of the uninsured are eligible for Medicaid under the expansion, which makes the processing even simpler. You limit the number of users, the number of private insurers, and the number of potential plans by doing this at a single state level. The same would not be true for CA, TX, or probably even FL or NY, where there are simply more people and more players. I believe the states that didn't do their own Medicaid expansion or their own website dumped into the federal government's lap something that is simply too big to manage. I know a lot of money was spent, but can you imagine trying to get all of that data to work back and forth with all of those players? If one of the insurers didn't play ball, did the federal site just kick them out of the exchange? If one of the states waited until the last possible minute to say no to doing their own, what position does it put the DHHS? What about the infrastructure and the development teams? I hear comparisons on TV to Facebook or other mega websites. The comparison is wrong. Every major website I can think of started as something small and built up to what they are now. A dorm room, a garage, or someone's basement, up to a bajillion dollar a year giant. You don't just set a date for a website and say, "Have at it." I can't even think of an instance where this user count has ever been dropped onto a single site on its first day.....can you? Is it possible to make it work? Absolutely. Is it simple? Heck no.
Kentucky has a special demographic requiring custom forms. For example in the section where you indicate the relationship to the account holder they had to add a checkbox options that read "wife and daughter".
82% of those counted as signing up for ACA actually signed up for medicade and won't be contributing financially to the ACA program. If this is success, then failure must be the objective.
"What are you, Catholic? We need to control people through guilt and shame? Really? That's a US view that's not seen elsewhere"
Why is it that all you people on the left recoil at the idea that anybody should be responsible for him/herself and that part of that mechanism ought to be shame for those who do not, and pride for those who do? You seem to have no problem hurtling all manner of insults at productive people if they object in any way to your use of the government to TAKE by FORCE what you want. You all appear to hold the view that decent, productive citizens should stand still and allow themselves to be robbed at gunpoint with the proceeds funneled to the lazy/incompetent and you demand they feel SHAME and GUILT if they resist or object to your theft-by-proxy politics. You are not content to just commit the mugging (well, you lack the guts to do it yourselves, so you have the government do it on your behalf) you insist that the recipients of the stolen goods should not even feel guilt! Absolutely amazing!
If ANYBODY in society needs to feel shame and guilt it surely should be those who live as parasites on the backs of hard working people and ought to be motivated by any means possible to STOP IT. The arrogant presumption that a lazy or incompetent person has ANY moral claim on the work product of another human being is repugnant
No, this is a left wing parent telling their child to walk several miles to school because they don't believe in using fossil fuels for transportation. You see, because the law was deemed constitutional, their constituents have to comply with it as part of Federal Law. So instead of making it as easy as possible for your state's people to comply, you lump them in with 20-some other states who are also "protesting," resulting in a clusterfuck that they still have to deal with. You could have helped YOUR OWN people, and you chose not to just to make a political point.
Well done. I hope whomever runs against them points out how easy other states have had it, and that the only reason your constituents had to suffer through this awful roll-out was because of political posturing.
Is it just my observation, or are there way too many stupid people in the world?