How Kentucky Built the Country's Best ACA Exchange 333
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."
Hey rest of the country.... (Score:3, Insightful)
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.
Comment removed (Score:5, Insightful)
Not all republicans are republitards (Score:0, Insightful)
Well it seems those hillibillies really have the basics anchored down. Good for them.
KY gets it (Score:5, Insightful)
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.
Re:Not all republicans are republitards (Score:5, Insightful)
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.
Health exchange sabotage (Score:5, Insightful)
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.
Re:Wow. (Score:5, Insightful)
"[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.
Re:Wow. (Score:5, Insightful)
"[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.
Re:Wow. (Score:5, Insightful)
Re:Wow. (Score:5, Insightful)
Re:Attn: Slashdot Socialists!! You Are Screwed. (Score:5, Insightful)
I agree with your criticism of Obamacare. The answer is to have real "socialism", like in Canada, Japan, Australia, and most of Western Europe. Then we could save a third off the top. Total US healthcare expenditures are 50% greater as a percentage of GDP than any other country, for no more care and no better results.
I'm too much of a cheap bastard to worry about ideology.
Re:Attn: Slashdot Socialists!! You Are Screwed. (Score:2, Insightful)
There are some of us in other parts of the civilized world that just go WTF at the total mess that is the US Healthcare System. To say it is Fucked Up would be generous.
Thank god the politicians on all sides got together towards the end of WW2 and gave birth to the UK's NHS. Paid for out of general taxation and free at the point of delivery to everyone. I pay approx $200/month out of my earned income but even that ends when I reach official retirement age. from then on it is free. No loss of benefits if you are out of work either.
so we get called Socialists/commies/or worse by big sections of the US politicos and media. so fucking what. With our healthcare sorted we can get on with other things free from worrying how we are going to pay for healthcare.
You Yanks really should get your act together and join the rest of the developed nations and have a decent system. The aim you seeming have of making every Doctor a millionaire is just stupid.
I lived and worked in MA for several years. Luckily my employer took care of all my insurance. But to hear two medics arguing over who was going to be able to put in a bill for my treatment was the final straw. My family & I returned home soon afterwards.
Fuck the American Dream. If that makes me a rabid commie then so be it.
Re:Attn: Slashdot Socialists!! You Are Screwed. (Score:4, Insightful)
Good theory, but do you have an example of that working in the 21st century? If not, I'll stick with facts and empiricism, and go with what works in dozens of countries around the world.
Ironic (Score:5, Insightful)
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.
Re:KY gets it (Score:3, Insightful)
Its called the iterative process. Make small thing test it run it verify it, make small test it run it verify it... Do it in small chunks so you can at least have a shot at having your integration work worth a damn.
I worked on one project totally hit all the marks. Hit all the performance, memory, blah blah blah... Nice simple iterative project. Just continue iterating and the project would have new features every 1-3 weeks. Another group took over didn't like the 'style' (naming) thought it was 'too hard to read' (spacing). As if they have never heard of a pretty printer (even though I told them about it 20 times). A refactor was maybe 2-3 weeks of work to match the naming the way they wanted it (even though it was fine). So they threw the whole thing out. Rewrote the whole thing from scratch. Did not bother with the original requirements (at first until it got to QA). Was more concerned with 'cool stuff' and 'how they feel' about naming. 8 months on and many 80-90 hour weeks they still have not matched the original code in performance, size, and features. They went monolithic design.
I screamed yelled whatever no one cared. I dont care anymore. Last projection they had another 2-3 months of work to 'get it working'. The whole original project took 1 plus another 6 of iterations and 0 overtime. They come to me for questions 'its your project and your code you wanted it so badly live with it'. I spent months warning them they were setting themselves up for a death march. But they didnt care. They felt good about the naming.
Best complement I ever got was 'your code is super easy to read'. The worst one 'I dont feel good about the style of the code'. Two different people. One liked the ease of flow. The other didnt like it because it didnt match the style guide for the company he used to work for (as if I have access to it). My style guide fits on an napkin his takes 40 pages.
Why did I go on a rant about style? Because complexity for complexity's sake. That is how we end up with it. Everyone wanting to redesign things that *do not need it*. I get refactor, I get reuse, I do not get throw it out and start over. Many times it is done for no real good reason. So you end up with 20 programs that sorta do the same thing.
Testing and feature prioritization? (Score:5, Insightful)
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.
Re:Wow. (Score:5, Insightful)
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.
Re:KY gets it (Score:4, Insightful)
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:
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:
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
I'm not from Kentucky but (Score:5, Insightful)
The takeaway should be the that the KY developers properly understood that they need to make the site as widely accessible as possible.
Re:Health exchange sabotage (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 this on people who do not want it. We do not think it can work and we will not be complicit in forcing it on them." Now, you are blaming them because it did not work, just like they said it wouldn't.
I'm sorry, when you put something into place over the objections of people who do not want what you are doing, even if it would work, you do not get to blame them when it doesn't work. The Democrats insisted on implementing this. If they were unable to make it work without the Republicans help, they should not have tried, since the Republicans made it clear that they were NOT going to help.
Re:Wow. (Score:1, Insightful)
Also, given the generally negative effects of both poverty and ill-health on things like school attendance and performance
More accurately, the negative effects of govt programs which have fostered dependency which has in turn caused the proliferation of social pathologies including poverty and low educational achievement. The very worst communities are those which have fallen the furthest down the rat-hole of progressive social programs.
there is a fairly strong incentive to make these mechanisms accessible even to adults who are probably permanently screwed at this point.
From a rational standpoint, the incentive is to wean those adults off of govt programs, not to introduce them to yet another one, esp. one which is so inherently destructive and dysfunctional as Obamacare. The moral hazards of charity, esp. the impersonal, coerced charity of govt programs, has been understand for centuries. Sadly, the power-hungry and the well-intentioned, but naive, keep destroying people's lives by pushing more people into govt dependency.
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.
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. Unfortunately, progressive political ideology seeks to eliminate all societal standards of behavior and the very concept of of personal responsibility in a misguided attempt to create an impossibility: an enduring culture in which no one ever has to feel shame or guilt. 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.
Re:Hey rest of the country.... (Score:5, Insightful)
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?
Re:I'm not from Kentucky but (Score:3, Insightful)
Re:Wow. (Score:5, Insightful)
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)..
Re:Wow. (Score:5, Insightful)
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.