HealthCare.gov website stumped the millennials

Study reveals where designers erred

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Mil­len­ni­als who strug­gled to sign up for health in­sur­ance on HealthCare.gov have some sim­ple ad­vice for the Obama ad­min­is­tra­tion: Make the web­site more like Yelp or Tur­boTax.

Pres­i­dent Barack Obama fa­mously told doubt­ers that they could use the gov­ern­ment’s health in­sur­ance site to pick a health plan “the same way you shop for a plane ticket on Kayak, same way you shop for a TV on Am­a­zon.” Speak­ing at a com­mu­nity col­lege in Mary­land last fall, he prom­ised that the pro­cess was “real sim­ple.”

That turned out not to be the case, of course. A study pub­lished Mon­day by An­nals of In­ter­nal Med­i­cine lays out some of the spe­cific ways that HealthCare.gov — a cen­ter­piece of the Pa­tient Pro­tec­tion and Af­ford­able Care Act — went wrong.

A team of doc­tors, law­yers, health econ­o­mists and health pol­icy ex­perts from the Univer­sity of Penn­syl­va­nia re­cruited 33 vol­un­teers and ob­served them as they strug­gled to sign up for health in­sur­ance on the highly touted web­site. These vol­un­teers should have been in pretty good shape: With ages rang­ing from 19 to 30, they were all mem­bers of a Web-savvy gen­er­a­tion. In ad­di­tion, the study de­scribed the young adults as “highly ed­u­cated.”

But when they got to HealthCare.gov, they ran into prob­lems. Some of them had an­tic­i­pated that they could type in their pref­er­ences — what ser­vices they wanted to have cov­ered, how much they wanted to spend on pre­mi­ums, how much flex­i­bil­ity they want in pick­ing their doc­tors — and get a list of op­tions that met their cri­te­ria. (It could have been the health in­sur­ance equiv­a­lent of us­ing Yelp to find a su­shi bar near a cer­tain city that has out­door seat­ing and takes res­er­va­tions.)

In­stead, the vol­un­teers had trou­ble match­ing their pref­er­ences with ac­tual plans, ac­cord­ing to the study. The re­search team said this was partly be­cause of the “over­whelm­ing” amount of in­for­ma­tion the web­site dis­played.

As one of the vol­un­teers told the study au­thors: “I would love a tool where it’s, like, is it im­por­tant that you have den­tal cov­er­age? Check this box. Do you want men­tal health cov­er­age? Check this box. ... [A]nd then have it gen­er­ate: These are the plans that most closely meet your needs.”

Another hur­dle was vo­cab­u­lary. Plenty of terms on HealthCare.gov were “in­ad­e­quately ex­plained,” as the study au­thors put it. What is the dif­fer­ence be­tween a PPO, an HMO and an HSA? How is a de­duct­ible dif­fer­ent than a co-pay? When site us­ers ran into these con­fus­ing terms, they got stuck.?

Barack Obama


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