The "chaos" of Obamacare just got a little less chaotic. On Tuesday morning, the Obama Administration released its new insurance application, for use on the new health insurance marketplaces. The marketplaces are for people without employer-sponsored coverage, and the idea has always been to make the application process as simple as possible.
Here’s how it’s supposed to work: You go online. You enter some basic information about your family, income, and employment status. You find out what kind of insurance is available to you, whether it’s Medicaid or a regulated private insurance plan. And you find out whether you’re eligible for financial assistance that can reduce the premiums—or, depending on your income, eliminate the premiums altogether.
Sounds great, right? It didn’t look so great in March, when the administration released a prototype of the application. The paper version was 15 pages long for a family of three. That’s not quite as bad as it sounds. The form would have appeared shorter online, and not everybody would have been forced to fill out the entire thing. But many people still found it intimidating—among them, Ricardo Alonso-Zaldivar of the Associated Press, who was the first to obtain a copy. “The idea that picking a health insurance plan could be as simple as shopping on the Internet is starting to look like wishful thinking.”
To be fair, buying insurance was never going to be as simple as buying a book on Amazon. How could it be, given that, at the very least, the government needs to know your income and employment status? But administration officials say they listened to the critics and, after the initial release, made a concerted effort to simplify. They consulted with attorneys about which information was absolutely essential and which could be left off. They sought out communications consultants—folks with no particular expertise in health policy—and had them edit the forms. Then they tried out new language on sample groups. Originally, administration officials say, their goal had been to create a form that every single person could use. But that goal made things a lot more complicated, because it meant anticipating every possible contingency. With the revision, administration officials settled on a form that will suffice for the majority of people. (The minority who need to submit extra information—say, because they’re filing their application through a third party—can do so with supplemental forms.)
The result is a new, sleeker application. (You can see the full family version here.) Instead of two questions about spoken language, there is one. A question asking whether people wanted information via text message is gone altogether, because the administration realized nobody was interested in that option. The old form asked people to list, separately, different types of income tax deductions. The new one has one, generic question asking for the total of all deductions. I tried the application myself and it took me less than ten minutes to fill out the whole thing. Apparently that’s pretty average: Administration officials say that, in their tests, the average completion time was seven minutes. And I’m not the only one impressed. Time’s Joe Klein, who was among those criticizing the old application and the first to report on the new one, says the improvement “shows the Administration is alert and flexible and responsive—and, if we’re lucky, may turn out to be innovative in enacting a system that will bring health care to those who haven’t had it before, and lower costs to the self-employed masses who’ve had to go out and buy insurance on their own.”
That last point is critical. And to fully appreciate it, you should compare it to some of the applications available today. In my home state of Michigan, as in many states, the largest insurer selling individual coverage is Blue Cross Blue Shield. The application for its “One Blue” plan—you can see it here—is longer and more complicated than Obamacare’s. And if you look closely, you’ll see why. The application has a whole page of questions about prior medical conditions.
Blue Cross of Michigan wants to know about this because, like most insurers selling to people individually, it is worried about attracting poor medical risks—the kind of people who might run up big bills. And, like most insurers, its defense mechanism is to raise premiums, withhold specific benefits, or deny coverage altogether any time somebody has pre-existing medical conditions (although Michigan law places some restrictions on the insurer's ability to do so, under certain conditions). If you want to know which conditions attract scrutiny, you can consult a Blue Cross of Michigan underwriting guide. The list of “unacceptable medical conditions,” which you’ll find on page 23, starts out like this: “Abnormal pap (unless there have been 2 subsequent normal ones), Addison’s disease, Adrenal gland disorders, AIDS, ARC (AIDS related complex), HIV+, Alcohol abuse or alcoholism (unless 12+ years since recovery), Amyotrophic lateral sclerosis (ALS), Alzheimer’s disease, Aneurysm, Angina pectoris, Aplastic anemia, Arteriosclerotic heart disease, Atrial fibrillation or flutter, Ascites, Autism and Aspergers syndrome, Autoimmune diseases." Highlights later in the alphabet include Cancer, Congenital Disorders, Heart Murmurs, Lupus, Parkinson’s Disease, and, of course, Pregnancy.
Now go back to the Obamacare application and look for the questions about medical history. You won't find any. That's because, once the law is in effect, medical history won’t matter. Insurers won’t be able to treat the healthy and sick differently. That alone is a huge change for the better.
Of course, there are still a million things that could go wrong between now and October, when the new exchanges are supposed to open for business (so that coverage can become effective on January 1). When it comes to eligibility, the biggest challenge isn’t getting the information. It’s processing that information properly, so that people end up with the right kind of coverage, and at the right price. Given the complexity of the system, and active resistance of so many officials at the state level, some problems with implementation are virtually inevitable—and, based on what I’ve been hearing, more likely than not to happen. But this new form is another sign that things won’t go as badly as some people fear.