Thoughts on health insurance

Last month we left our jobs and moved to a new state and we’ve been trying to figure out what to do about health insurance. The best way to sum up the experience is “ugh.” More thoughts:

  • First let me share my vague personal beliefs: The United States is sufficiently advanced such that all people should receive medical care even if they’re not able to pay for it themselves. Yes, that means I think people with more money should be subsidizing (or completely paying for) medical care for people with less money. Health care and insurance are complicated and I’m not foolish enough to think I can express an informed opinion about the best way to implement this. I don’t feel strongly whether “all people” is only permanent residents, or also people with valid visas, or also people without valid visas. My preference from a humanitarian standpoint is to provide care for everyone regardless of legal status. I don’t feel strongly about how it’s paid for… whether everyone’s care is 100% covered by tax revenue or whether people who can afford it are charged coinsurance or a copay. I don’t feel strongly about what medical care should be covered and what shouldn’t (Vaccines: Yes. Non-medically necessary cosmetic surgery: Maybe not? Though it’s complicated.).
  • The Patient Protection and Affordable Care Act (“ACA” or “Obamacare”) is a move in the right direction. It placed a bunch of requirements on health insurance and established the HealthCare.gov marketplace.
  • Health insurance is expensive. Yes that’s a problem. Sure, maybe the ACA’s requirements contributed to higher prices, but also the requirements are useful consumer protections, so 🤷.
  • It seems like there might be insurance plans that aren’t listed on HealthCare.gov. These are called “off-market.” It seems like the reason for them to exist is that, while they still must adhere to federal ACA requirements, they might not have to adhere to state requirements? I’m not sure. I don’t know if any such plans exist for North Carolina—I couldn’t find any.
  • Short-term health insurance is a thing. These plans don’t have to adhere to the ACA. They’re not listed on HealthCare.gov. I thought they were hard to find, hard to compare, and hard to be confident that plans weren’t lacking something important. eHealth is one website for viewing plans. The premiums are lower because the coverage is worse. They were tempting, but we went with a full HealthCare.gov plan in part because I found the ACA’s regulations/requirements reassuring.
  • Since late 2016 short-term insurance plans could only be used for three months. In 2019 this was changed to one year and renewable up to three years. That makes short-term insurance plans a viable option for more people, which means more healthy individuals will sign up for short-term insurance, since it’s cheaper, which means fewer healthy individuals will sign up for ACA plans, which means the cost of the ACA plans will increase. It moves toward a more free market, but I think our society benefits when health insurance is more heavily regulated. This is a step in the wrong direction. It basically allows people to opt out of the protections of the ACA. I don’t understand why short-term insurance was allowed under the ACA. It seems like any reason someone would have for using short-term insurance would qualify them for a special enrollment period for a full health plan.
  • In 2017 the fine for not having health insurance (the “insurance mandate”) was eliminated. Similar to above, this is a step in the wrong direction. It removes healthier individuals from the ACA pools which means ACA insurance will be more expensive for less-healthy individuals.

Specific HealthCare.gov complaints

HealthCare.gov, the federally operated health insurance marketplace, works decently well. It’s better than most government, insurance, HSA, etc. websites I’ve used but there’s still room for improvement. Examples:

  • I got to a point in the application process where I could view all the available plans and compare them. I had to leave and come back to this over the course of weeks while I researched the best insurance option for the four of us. Each time I had to reconfirm a few selections I’d already made: Whether I wanted to list any primary care doctors (to check if they’re in-network, I assume), how much medical care each of us needed (low, medium or high), and whether to group the four of us together or split us up. Ideally I would have been able to go directly back to the list of available plans. Perhaps this only happened for me because I chose “skip” for the “primary care doctors” question.
  • If my session expired while my laptop was off and then I tried to use the website again, the error page was poor. I think it indicated that the URL was invalid without saying anything about the session having expired. I think it did not provide an easy way to log back in or resume where I left off.
  • After I picked a plan I saw some messages that used the acronym “MEC” without defining it. I don’t recall seeing this acronym anywhere else and it doesn’t seem common. It should have been written out or defined somewhere nearby.
  • Here’s a screenshot of an email I received:

    What’s up with those “YYYYMMDD” hints? While I love writing dates with year first then month then day, having to explain the date format is an indication that it’s a poor date format. This should be written as either “2019-05-27” or “May 27, 2019.” And the second “(YYYYMMDD)” hint shouldn’t be there at all since no specific date is displayed (just the word “soon” for whatever reason).
  • Check out this other screenshot, this one from the website:

    A few problems here.

    1. I don’t know why the upload failed. I don’t think it was my fault. I tried the same file later and it worked, so it does seem like “try again later” was accurate. It’s possible that logging out and logging in with a new session was enough to cause the upload to work. Either that or uploading was broken for a time. In either case this seemed like the fault of HealthCare.gov and not me.
    2. After clicking “SELECT FILE TO UPLOAD” and selecting a file I then had to click the green “UPLOAD” button next to the file name to actually upload the file. This second step shouldn’t exist. It adds unnecessary complication and it’s easy to not realize that it’s necessary.
    3. For the file size, the “b” in “Kb” should be capitalized. Lowercase “b” means “bits” and uppercase “B” means “bytes.” The latter is almost always used when talking about file sizes. Bits are typically only used when talking about data transfers at a low level (“the computer sent 156 Kb of data before disconnecting”) or when talking about data transfer speeds (“broadband means 25 Mbit/s or faster”).
    4. The file size should probably be displayed in megabytes instead of kilobytes, since file sizes are generally displayed in the biggest possible prefix that has a non-zero value. So this should be 1.59 MB.
    5. There should probably be a bit of spacing between the white content box and the “TAKE ME BACK” button.
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