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."
Attn: Slashdot Socialists!! You Are Screwed. (Score:2, Interesting)
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?
Re:Health exchange sabotage (Score:5, Interesting)
Re:Wow. (Score:5, Interesting)
Different states = experiments (Score:5, Interesting)
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?)
Re:Wow. (Score:5, Interesting)
Did the article author actually attempt to apply? (Score:5, Interesting)
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.
World flipped upside down (Score:4, Interesting)
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?
Re:Wow. (Score:5, Interesting)
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.