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How Kentucky Built the Country's Best ACA Exchange 333

Posted by Unknown Lamer
from the keep-it-simple-strikes-again dept.
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."
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How Kentucky Built the Country's Best ACA Exchange

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  • by Anonymous Coward on Tuesday October 29, 2013 @08:14AM (#45267619)

    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.

    • Re: (Score:2, Informative)

      by ebno-10db (1459097)

      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".

      • by neurovish (315867)

        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".

        You obviously didn't pay much attention to Deliverance or Dukes of Hazzard. Both are set in northern Georgia.

    • by div_2n (525075) on Tuesday October 29, 2013 @11:16AM (#45269481)

      We Kentuckians aren't all ass-backwards anymore than all Californians are LA gangsters or all New Yorkers are mobsters.

      If you want to say "an economically depressed state with generally fewer technological resources than others beat you" then fine. But try to avoid stereotypes mmmkay?

  • KY gets it (Score:5, Insightful)

    by drinkypoo (153816) <martin.espinoza@gmail.com> on Tuesday October 29, 2013 @08:17AM (#45267647) Homepage Journal

    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.

    • >> and then worry about the pretty pretty

      For that matter, most sites can forgo pretty altogether.

      Google, Zillow, Amazon, Wunderground were all more usable and useful when they were simple.

      • by ApplePy (2703131)
        Very true. Most websites could learn a thing or two from Craigslist. Function over Form, KISS.
    • Re:KY gets it (Score:5, Informative)

      by T.E.D. (34228) on Tuesday October 29, 2013 @09:39AM (#45268421)
      This is actually a basic principle of what we today call iterative design [wikipedia.org], and back in days of yore called Worse is Better [wikipedia.org]. Its not a new concept.
    • If everyone is doing something that seems stupid to you, then either everyone else is stupid or you are missing something.

      The bells and whistles in those cases are perhaps more to generate buzz among non-nerds. If I go to say university website and it has all the information (like address) I need in plain black text on plain white background, and I can ctrl+F and get on with my life in a second, I appreciate that. However, for every one person like me who doesn't want any frills, there are a dozen sill
      • by pscottdv (676889)

        The bells and whistles in those cases are perhaps more to generate buzz among non-nerds. .

        I don't believe that for a second. Non-nerds want an attractive page to look at and a design that works well. Most AJAX I see looks to me like someone is padding his or her réumé.

      • by tlhIngan (30335)

        The bells and whistles in those cases are perhaps more to generate buzz among non-nerds. If I go to say university website and it has all the information (like address) I need in plain black text on plain white background, and I can ctrl+F and get on with my life in a second, I appreciate that. However, for every one person like me who doesn't want any frills, there are a dozen silly people who will complain about how boring the website is and oh can't we do better and maybe highlight some of the unique fea

    • Re:KY gets it (Score:4, Insightful)

      by T.E.D. (34228) on Tuesday October 29, 2013 @09:48AM (#45268525)

      In fact, perhaps it is time to repost this on Slashdot for today's fresh audience of developers, lest our classics be forgotten:

      The Rise of Worse is Better [jwz.org]

      I and just about every designer of Common Lisp and CLOS has had extreme exposure to the MIT/Stanford style of design. The essence of this style can be captured by the phrase ``the right thing.'' To such a designer it is important to get all of the following characteristics right:

      • Simplicity-the design must be simple, both in implementation and interface. It is more important for the interface to be simple than the implementation.
      • Correctness-the design must be correct in all observable aspects. Incorrectness is simply not allowed.
      • Consistency-the design must not be inconsistent. A design is allowed to be slightly less simple and less complete to avoid inconsistency. Consistency is as important as correctness.
      • Completeness-the design must cover as many important situations as is practical. All reasonably expected cases must be covered. Simplicity is not allowed to overly reduce completeness.

      I believe most people would agree that these are good characteristics. I will call the use of this philosophy of design the ``MIT approach.'' Common Lisp (with CLOS) and Scheme represent the MIT approach to design and implementation.

      The worse-is-better philosophy is only slightly different:

      • Simplicity-the design must be simple, both in implementation and interface. It is more important for the implementation to be simple than the interface. Simplicity is the most important consideration in a design.
      • Correctness-the design must be correct in all observable aspects. It is slightly better to be simple than correct.
      • Consistency-the design must not be overly inconsistent. Consistency can be sacrificed for simplicity in some cases, but it is better to drop those parts of the design that deal with less common circumstances than to introduce either implementational complexity or inconsistency.
      • Completeness-the design must cover as many important situations as is practical. All reasonably expected cases should be covered. Completeness can be sacrificed in favor of any other quality. In fact, completeness must sacrificed whenever implementation simplicity is jeopardized. Consistency can be sacrificed to achieve completeness if simplicity is retained; especially worthless is consistency of interface.

      Early Unix and C are examples of the use of this school of design, and I will call the use of this design strategy the ``New Jersey approach.'' I have intentionally caricatured the worse-is-better philosophy to convince you that it is obviously a bad philosophy and that the New Jersey approach is a bad approach.

      However, I believe that worse-is-better, even in its strawman form, has better survival characteristics than the-right-thing, and that the New Jersey approach when used for software is a better approach than the MIT approach.

      Let me start out by retelling a story that shows that the MIT/New-Jersey distinction is valid and that proponents of each philosophy actually believe their philosophy is better.

      Two famous people, one from MIT and another from Berkeley (but working on Unix) once met to discuss operating system issues. The person from MIT was knowledgeable about ITS (the MIT AI Lab operating system) and had been reading the Unix sources. He was interested in how Unix solved the PC loser-ing problem. The PC loser-ing problem occurs when a user program invokes a system routine to perform a lengthy operation that might have significant state, such as IO buffers. If an interrupt occurs during the operation, the state of the user program must be saved. Because the invocation of the system routine is usually a single instruction, the PC of the user program does not adequately capture the state of the process. The system routine must either back out or press forward. The r

  • by Anonymous Coward

    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 abo

  • by Required Snark (1702878) on Tuesday October 29, 2013 @08:29AM (#45267741)
    Remember, the original plan was to have every state do their own exchange. It was never intended that the federal exchange would be doing a large percentage of the work. One big exchange is riskier and much more difficult then 50 state sized exchanges.

    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.

    • by hrvatska (790627) on Tuesday October 29, 2013 @08:43AM (#45267863)
      My son just applied for insurance for his family through the NY exchange. I sat with him through the process just to see what it was like. The process was pretty painless and he found a plan that offered the same coverage as his current one for about $250 per month less. What I didn't like about the process is that you had to officially register in order to comparison shop.
      • New York did a damned poor job advertising its own exchange... this is the first I've heard of it. Most people in states with their own exchanges are still probably trying to get on the Federal site, which certainly won't help the current issues.

        • by hrvatska (790627)
          Once he selected NY as his state he was presented with a link to the NY site. That happened at the beginning of the federal site, before he started entering registration data. Once he got onto the NY site he had to enter registration data before he could compare plans.
          • I couldn't get the federal site to work long enough to get that far. Ended up Googling it and went directly to the NYS site. The cheapest insurance option offered was only $10/mo less than I have now and the whole thing was a huge pain in the ass if you're looking for anything remotely specific (hearing aid coverage in my case), but it's workable if you have patience.

            On the bright side, I already had an ID and didn't need to re-register thanks to using the surprisingly decent NYS DMV website in the past.

    • Re: (Score:3, Informative)

      by gtall (79522)

      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.

      • by Talderas (1212466)

        You mean the whole bit where the United States decided to embargo Japan instead of leaving them the fuck alone which prompted Japan to contemplate an attack on Pearl Harbor?

        • You mean the whole bit where the United States decided to embargo Japan instead of leaving them the fuck alone which prompted Japan to contemplate an attack on Pearl Harbor?
          Wow, somebody really wasn't paying attention in History class when covering 1933-1941. Newsflash, the US didn't embargo Japan just to be dicks, they did it b/c the Empire of Japan had spent the previous years fucking up Manchuria.
    • Ironic (Score:5, Insightful)

      by Overzeetop (214511) on Tuesday October 29, 2013 @09:31AM (#45268285) Journal

      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.

      • 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.

        More like "the Feds want an Exchange, let them pay for it".

      • Yes, it's amazing that the states led by people who don't believe the law is Constitutional don't want to have a hand in ripping the Constitution to shreds.

        What hypocrites!

    • by thoth (7907)

      The Republicans want government to fail, so it does.

      So true! Ideally, it would also fail in a manner to generate business for the 1%.

    • Re: (Score:2, Insightful)

      If the people in charge want it to work, they can make it work.

      So, what you are saying is that the Obama Administration wanted this to fail, because they are in charge of healthcare.gov. Not only that, but they were able to get this law written however they wanted. They chose to have the law written so that it would be their responsibility if the states did not choose to build their own exchanges. They thought they were blackmailing the states into setting up exchanges. The Republicans governors said, "Our voters don't want this system. You are insisting in forcing thi

  • by MikeRT (947531) on Tuesday October 29, 2013 @08:43AM (#45267861) Homepage

    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.

  • by GlobalEcho (26240) on Tuesday October 29, 2013 @09:22AM (#45268225)

    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?)

    • by thoth (7907)

      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.

      And that's one of the biggest weaknesses as well. Confederacy was tried twice and both failed.

      Look at the struggles of the US building infrastructure like broadband - a loose organization of municipalities and states means thousands of separate jurisdictions to deal with.

      Corporations can exploit various differences and form in one state, do business in another - to avoid or partially avoid laws, etc.

  • How did KY do it, you ask? What's their magic secret?

    weeks after the U.S. Supreme Court upheld the Affordable Care Act, Democratic Gov. Steve Beshear

    There's your answer right there.

    • Well the Democratic leaders of Healthcare.gov sure didn't manage to make a usable site. So party affiliation has less to do with it than you think.

  • by EmperorOfCanada (1332175) on Tuesday October 29, 2013 @09:40AM (#45268435)
    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.
  • by CmdrPorno (115048) on Tuesday October 29, 2013 @09:49AM (#45268537)

    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 [kentucky.com] about child fatalities which occur under their watch.

  • by mu51c10rd (187182) on Tuesday October 29, 2013 @10:39AM (#45269055)

    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 [gotohellmi.com] freeze over or something?

Time to take stock. Go home with some office supplies.

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