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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."
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.
Yes, as opposed to Vermont where we set the bar so high nobody can use the state's site.
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.
Mandatory XKCD.
http://xkcd.com/1133/
The only flying space car that's taken anyone to another world.
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?
Well, the democratic governor did it via executive order while the republicans tried to deny them office space to do the work. I wouldn't give the republicans too much credit. This seems more of a success in spite of them not because of them.
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?
"[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.
Yes they did.
It's far more difficult to write simple and easy to understand text than it is to simply copy & paste legalese.
The target demographic of this site is every adult living in the state, so it should be accessible to every adult.
Slashdot social media options: AIM, ICQ, Yahoo, Jabber and Mobile Text. Why no MySpace?
"[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.
What I want to know is who they had to waterboard to get insurance companies to provide information about their policies written at a 6th-grade level...
Mine alternates between issuing cryptic tomes (with pictures of happy, smiling, healthy people on the front, naturally) that alternate between dense medical-billing-and-coding jargon and EULA-like 'eh, you'll discover what we don't cover after you've had the procedure' disclaimers.
As much as I enjoy making fun of the developing world, why should we permit vital, allegedly mutually-consensual, contracts to be couched in language that a substantial portion of the people who 'agree' to them aren't capable of understanding? Without mutual understanding, much less mutual consent, centuries of contract law are reduced to a mockery.
Also, given the generally negative effects of both poverty and ill-health on things like school attendance and performance, there is a fairly strong incentive to make these mechanisms accessible even to adults who are probably permanently screwed at this point. Even if it's too late to do much more than write them off, they are the ones we need to work with if we want to head off the next generation of probably permanently screwed people before it's too late.
What I want to know is who they had to waterboard to get insurance companies to provide information about their policies written at a 6th-grade level
They probably had someone outside of the insurance companies do the translating, though I do prefer your waterboarding approach. Oh, that sounds so harsh. Better to call it "enhanced contract interpretation".
RI's system kind of, sort of, works. However I applaud Kentucky for understanding KISS - Keep It Simple Stupid. That's something that seems be thrown out the window in most web development projects.
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.
"We are going to achieve a consensus ad idem concerning this medical coverage policy, by one method or another. Now, would you like to do this the easy way, or are you going to make me do it the hard way?"
I'm a Kentuckian of several generations on both sides; I wrote my first computer program in Kentucky. It makes me happy to see our exchange is doing well. One thing about Kentuckians: we may not always know everything, but we know what we don't know and aren't generally too proud to try to remedy it given the means.
"The wisdom of the Patriarchs was that they *knew* they were fools." --Master Foo
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?
As a programmer currently living and working in Kentucky, I am also proud of the state's website offering. Of course Obamacare should be thrown on a fire, and it will probably be crushed under its own weight if not heavily modified, but I'm glad we made a functional website.
Dark Reflection
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.
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.
While training to be a journalist in the 1970s we were taught to write at that level also. Reading at that level will take you through The Atlantic, National Geographic, Outside Magazine, Consumer Reports, The New Yorker, WebMD, Wikipedia, Reuters, Washington Post, New York Times. Considering the state of literacy in America, "setting the bar higher" would be stupid for a website designed to serve the public with health issues. If you happen to think this bar is too low, try walking into a classroom where kids have to learn to read, and teach them. Try teaching people to read when they grow up in poverty, a big problem in all states, including Kentucky. I've lived there. My own father had to get a GED because when he was in ELEMENTARY school he had to drop out to get a job so his family could get by. Over-privileged, over-bred, snarky people may look down at the unwashed masses. But those who grew up in comfortable homes with parents who had the time and resources to focus on their kids' education have lived soft lives. They haven't had to rise above it. In my childhood my father knew I had to graduate from high school. He told me he'd beat the hell out of me otherwise. But even though he knew the value of a high school education in the workplace, he still had no concept of the value of college. I've had to struggle to get where I am today, and many of the people I lived with in Kentucky still struggle just to make a living. I hated living there and won't do it again, but I'm damn proud that Kentucky, one of those states people laugh at, a Tea Party foothold, had the foresight to do something right that our glorious surveillance president couldn't get it right. And no, I'm not a right-winger. Just the opposite.
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
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.
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
"[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."
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.
Ok, what does that "say" for his ethics? Providing competition to the state-backed monopoly on a category of medical care sounds ethical to me.
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?
Theoretically we could represent every number like this: 1111111 instead of 7. So why do we have any numbers other than 1? Because it's much less work to write 1234 and manipulate those four digits than to write or type one thousand two hundred thirty-four 1's and count and/or manipulate them.
Or, referring back to Randall Munroe's Up Goer Five the term "helium" is shorter and more precise than "that kind of air that makes your voice funny." When I explained this to my nephew who's in kindergarten the latter was good enough; when he gets older and more interested in rocketry, I'll clarify using the former. But if I were a rocket scientist, or speaking to someone who was, I'd use the former term even though it's "harder."
I really probably shouldn't do this, since it's far too close to arguing politics on /., which everyone knows is a no-no, but...
Here's the thing, per the wikipedia page, which is as much research as I care to do about this, he got the board certification from the ABoO, then formed the NBoO because he and about 200 other ophthalmologists got their knickers in a twist about having to recertify, let that fall apart, then reformed it right before his original certification ran out. As of now the NBoO isn't recognized by anyone. That's problematic.
Certification is incredibly important in medical fields. If the chef at a restaurant doesn't know his stuff, you're gonna eat a steak that's overdone, if your ophthalmologist doesn't know his stuff, then you're blind for life. Someone's gotta be making sure that our doctors actually know what they're on about, the price of them screwing up is too high.
If you genuinely disagree with that, then let me know the next time you need surgery, with three days notice I can be board certified by the National Board of AreYouFuckingInsane Surgery, and I'll beat anyone else's price for your surgery by 25%. Don't worry dude, I"m like, totally qualified. I saw it on TV once.
Oh, and real quick before anyone brings up the whole recertification thing, Even if you're the best damn ophthalmologist in the world, if you don't keep up with the current science, you'll fall behind in much less than 10 years. The big bad secret about medicine is that we still don't really know how the human body works, we've just got a pretty good set of guesses, but we figure out ways that we're wrong all the time. Hell, I'm a paramedic, I deal with disease processes that we understand pretty well, and I have to recertify every 2 years, including proving I've done a whole bunch of continuing education.
I needed a sig so people would know who I am, but I was too drunk to make something witty, so you get this instead.
From a rational standpoint, the incentive is to wean those adults off of govt programs,
When you "wean" a baby off milk, you don't do it by starving them to death. You do it be introducing desirable alternatives. Yet the "wean" usually discussed is more like a drug treatment plan cold turkey. That's not a wean. If it is a wean, please specify the alternative they are being weaned onto, and how it's more desireable for the person being weaned than what they are on now.
It is extremely difficult to reintroduce the shame and stigma of receiving charity once a generation of children have grown up in families almost wholly dependent on govt programs and it is only that reintroduction which will cure the disease.
What are you, Catholic? We need to control people through guilt and shame? Really? That's a US view that's not seen elsewhere. And, having been to places where being on the doll/benefit isn't looked down on the way it still is in the US, the US has the worse system and still more "shame" to it. Yes, kids in school get picked on for having discount lunches. I've seen them beat up for it. And you want to make life harder on them because you feel there's insufficient "shame".
Shame and guilt are a sign of a conscience which is what keeps people from misbehaving without the need for the use of police force.
Doesn't work for corporate executives. They show shame and guilt when ordered by their lawyers, and yet offend at a rate greater than any minority slums (they just have legal representation to get the charged dismissed/reduced)..
Learn to love Alaska
I can't believe I'm responding to an AC.... but I hate this ideological shit.
I'm a progressive. I believe capitalism can build good things if government creates the basic infrastructure so that people can get on with their lives. I believe !@#$ing selfish "I got mine, fuck everyone else" Righties take that basic infrastructure for granted.
"negative effects of govt programs which have fostered dependency" You're pulling that out of your ass. I grew up POOOORRRRR... we got WIC, food stamps, lunch assistance. I got Pell grants to go to college. I assure you, I've paid back every dime and then some through my taxes. That's how the system is supposed to work, that's how it often works. You give someone a hand up, and they pay it back. Yes, there are exceptions. No, they are not the rule.
"the incentive is to wean those adults off of govt programs" Like what already happens?
"inherently destructive and dysfunctional as Obamacare" How would you know? We've barely started the damn thing. And what's so !@#$ing wrong about making everyone buy medical insurance? Where's the government takeover? What's the problem here?
"The moral hazards of charity" /eyeroll
"It is extremely difficult to reintroduce the shame and stigma of receiving charity " We're in the biggest recession since the !#$!ing Great Depression. Now is a fine time for a little charity. So fuck off. And we all know the "recovery" is fine at the top, but it's not over down here at the bottom.
"wholly dependent on govt programs" I hate this one most of all. My neighbors are Poor. 30 years old, 5 kids. They are the nicest people on the planet, they give, they have a wonderful family.... and they work HARD. Harder than me, harder than you. I grew up poor. I've seen it. Poor people work HARD. Often they have 2 or 3 jobs, they wake up early, the work late, they go to work sick so they don't get canned. Their KIDS work under the table! Fuck your myth of government dependance. If that family is getting help from the government, I'm happy for them.
If companies would pay a damn decent wage in this country, they wouldn't have to work so hard. But all those chain stores (which seems to be most of our economy these days) can pay low wages, and that's that. The companies COUNT on the government to pick up their slack with assistance.
"progressive political ideology seeks to eliminate all societal standards of behavior and the very concept of of personal responsibility" I never knew I was such a bastard. Here I thought I was for building basic infrastructure and getting the hell out of the way so everyone can make a buck and get on with their lives. I thought I wanted well regulated economic institutions, so we all can get on with our businesses without fearing undue risk with our protected money. Here I thought I just wanted justice for those that fucked our entire economy. Here I thought I just wanted the government to mind the constitution and not wiretap folks without at LEAST a rubber stamped warrant.
If progressives have one weakness, it's that we want things to be FAIR. We want a level playing field. Joe Millionaire Senator Buddy shouldn't be able to murder and hooker and get away with it just because he's rich. Rich people SHOULD pay more taxes ON THEIR EXCESSIVE wealth, because by the nature of DOING BUSINESS, they USE MORE OF THE INFRASTRUCTURE and BENEFIT FROM IT MORE than we little poeple do.
What bastards, us progressives.
The whole post above is an ideological rant that demonizes "the other guy". It's all too common, and I apologize for my own part in it above. Most Righties just want to be left alone. Everyone hates taxes. Everyone hates beaurocratic stupidity and money wasting. People feel powerless these days and it's too easy to blame "Them". But please, everyone, don't demonize the other side.
Also, I'm kind of hating how all these stories lately digress into ideological wars instead of commenting on the original topic. Kentucky built something good, to help it's citizens. Good for them! I hope it works.
"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.
So your idea of reforming welfare is to humiliate the recipients, remove children if there's any failure on weekly drug tests, and throw them off on a fixed schedule. I fail to see anything positive, like trying to help them get useful skills and become employable.
Last I looked, most people got on welfare because they hit a hard spot, and stayed on welfare for an average of three years (which means a lot of people on for a year or two for every welfare queen). The large majority are trying to get off welfare anyway, and I doubt public shame will be much of an additional incentive.
What we need to provide instead is job training and access to affordable health care and child care once they're actually working. (Most people don't move from welfare to a job with decent medical benefits, and losing medical assistance is a serious danger to a mother with a young child. The ACA should be very helpful here.) It's generally more effective to help somebody reach a goal rather than make their life miserable until they do.
As far as that Kindle Fire...a Fire is a general-purpose Android tablet, and that's quite handy to find a job. It's capable of surfing job boards and allowing access to gmail or such services, and all it requires is free wireless. It's much more convenient than waiting at a library or job center for a PC to free up. It's about as low-cost a way to get that functionality as you're going to get. If you actually wanted people off welfare, as opposed to making them as miserable as possible for no reason I see, you'd be in favor of cheap Android tablets for the poor.
"When you have eliminated the unacceptable, whatever is left, however improbable, must be the truthiness" - Holmes