A Hatchet Job from the AP on the Exchange Application

Ricardo Alonso-Zaldivar of the Associated Press took a swing at the draft Exchange eligibility application, which was released for review and comment by CMS back in January. The story seems to be getting picked up pretty widely but, unfortunately, its commentary seems, to my eye at least, to be way over the top and sensational. Here's the first line:

Applying for benefits under PresidentBarack Obama's health care overhaul could be as daunting as doing your taxes.

This is bound to get a lot of people worked up and scared, but it really is a long way from the truth.

First of all, it starts off by saying that the draft application runs 15 pages and doesn't mention until the very end of the article that there's a shorter application for those who don't want or know they aren't eligible government subsidies for purchasing insurance. 

If you look at the shorter six-page application for those who know they don't qualify for a subsidy, you'll see that it's really not all that onerous. It's actually an eight-page package, but two of the eight pages are instructions, and they're in large and accessible type. Page 2 is the standard information about the applicant: name, address, phone, email, preferred language, SSN, birthdate, and checkboxes for citizenship status and ethnicity and race (both optional).  Pages 3 and 4 ask for the same information about each person you're going to include in insurance coverage. Page 5 is about American Indian status, and requires a single checkbox if no one in your family is a Native American. Pages 6 is a signature page. The optional Page 7 lets you specify an "authorized representative" who can discuss your application on your behalf.

Frankly, this is the same information you complete on just about any form you fill out for any reason today, and it's hard to imagine how CMS could get away with asking you for less information. I've scratched my head again and again, and there's only one problem that I can see with the whole application--and I'll get to that later.

But what about the 15-pager that Alonso-Zaldivar plays up so much in his article, the one that he claims runs "counter to the vision of simplicity promoted by administration officials" and are raising fears that "a lot of uninsured people will be overwhelmed and simply give up?"

For starters, of the 15 pages, the same two pages repeat six times, since you fill out the same information about up to six people. And, yes, the questions do get a little complicated. They ask about the federal income tax filing status of each person and details about a person's current job and income. If you know the details behind the Affordable Care Act and its subsidy provisions, each of the things being asked makes sense. All this is trying to get to household income, since families with a household income up to 400% of the Federal Poverty Level are eligible for subsidies.

It would be nice, I suppose, if there was just a single line you could fill out that says: enter your household income: ___________ But, to figure out what should go in that box, you would have to know all the rules of what counts and doesn't count and work up to that . . . in other words, fill out all the information that's in those two pages per person.

As for the other pages, most of them can be skipped by answering a single question: Is anyone offered health coverage from a job? Does anyone have another health insurance now? Is anyone in your family American Indian or Alaska native? Do you want to name someone as your authorized representative? Answer no to these and you knock out four more pages from the fifteen. When you fill out an application online, you'll never even be presented with many of the questions.

The real problem is that figuring out household income and prior or other health insurance information is complicated and requires a lot of information. In his article Alonso-Zaldivar quotes Sam Karp of the California HealthCare Foundation, which on its own designed a separate model application and, one can only assume, knows the pain of trying to capture all the information needed to determine subsidy eligibility. Karp, the article notes, "gives the administration high marks for distilling it all into a workable form." And I love Karp's quote: "We are not just signing up for a dating service here."

But, I suppose "Government does a pretty good job asking complicated questions on health insurance application" just isn't quite as dramatic a story.

Oh, and one other small detail not mentioned by the AP: this same application will determine individuals' eligibility for Medicaid or CHIP programs, too. 

And that brings us to the one big problem with the whole application process that no one else seems to be picking up on. I'll touch on that in a later post.