President Obama is running a “tech surge” to fix the healthcare.gov website. He recommended that people who want to apply use phone lines, though he noted that wait times might increase. Cover Oregon is also non-functional and, in some ways, worse than the national site. Oregon’s website is not accepting applicants at all, and signup was disabled, even for brokers and certified assisters who were supposed to have the first initial access.
Due east, in Idaho, the health exchange accepted a no-bid contract with Applied Computing LLC, but is now looking to void the contract as the winning company (founded by a board member) is being paid twice its normal hourly rate. California’s website is up and running, but only 94,500 users — out of a population of more than 38 million — had even started applications by October 15th.
Washington looks fantastic by comparison. Our site has seen heavy usage, and the enrollment and application numbers continue to increase at a rapid pace. As of Monday, nearly 70,000 applications (awaiting only final payment, due December) and over 35,000 final enrollments had been completed. If all finished applications are finalized, the WA Healthplanfinder will have reached most Governor Inslee’s Health Policy Office prediction for the entire year: 130,000 individuals and families.
This is not to say there aren’t issues: Account signup requires a complicated password to increase security, but is sent in plain text to your email account when you change it, leaving your personal medical data, any income or tax data and your health plan data open to anyone who has access to — or can hack into — your email account. It's awkward to browse plans — only a few options are initially displayed and the initial sort criteria are not clear.
Even so, the choices are astounding, almost overwhelming, and the subsidies available are even more impressive — if you’ve got the right resume. There are more than 40 different plans offered to individuals through the current marketplace by BridgeSpan, AppleCare, DeltaDental, LifeWise, Group Health, Premera Blue Cross and a couple others. They range from catastrophic care coverage (deductibles of up to $6000), all the way up to gold coverage, with deductibles as low as $100. Premiums adjust correspondingly, of course.
Like Olympic athletes and LEED buildings, Washington state healthcare plans are rated by comparing them to precious metals -- bronze, silver and gold. Just roll with it. The lowest level of care, catastrophic (this one is not a metal), covers very little of your day-to-day medical expenses. In exchange, you pay a (supposedly) lower premium and it covers that $180,000 hospital stay after a car accident. But your deductible is high, and you can expect to pay most low-level health costs out-of-pocket. Bronze level plans are supposed to cover approximately 60 percent of your healthcare costs, while silver and gold cover 70 and 80 percent respectively. In exchange for increased coverage, premiums go up. The consumer is left to evaluate what is useful and affordable.
So how do those actually break down for real people?
A 26 year-old non-smoker, living in King County and making $30,000 a year without any dependents. The cheapest plan — less even than the catastrophic care option — is a bronze option from Coordinated Care, with a $148.84 monthly premium and a deductible of $6000. Upgrading to a silver plan with Coordinated Care (still the cheapest option) increased the premium to $196.10, but dropped the deductible to $1750. The most expensive plan — a gold option from Community Health Plan — clocked in at a monthly premium of $324.13 with a $500 deductible (and a $4,800 out of pocket maximum). This person does not qualify for any federal subsidies.
A 27-year-old single parent making $26,000 a year with one 7-year-old dependent. This family qualifies for $64.32 in federal subsidies. Household plan costs (which cover all family members and include the subsidy) started out at $93.67 for the minimum level of care. Silver level plans came in around $176, but moved from a $6000 deductible down to $750 (or $200, if you are willing to take double the out of pocket maximum and an emergency room co-pay). The most expensive gold level plan available through the exchange runs $279.95 and pulls the deductible down to $500, coming out to around 12 percent of total pre-tax income.
A family of four — 45 year-old parents with a 10 year-old and a 15 year-old making the average Seattle household income ($52,048). This family receives the most federal assistance, at $246.82. This is a result of large federal subsidy increases with age, and the fact that the family makes only $13,000 per member — significantly less than the single 26-year-old. The cheapest household plan clocked in at only $189.22 (with the now familiar $6000 deductible) — only $41 higher than the single 26-year-old. Plans increased dramatically from there though. A silver plan with a $2000 deductible ran a premium of $506.20, while the most expensive plan dropped the deductible all the way to $500, but brought the monthly premium to $702.78. This family had the widest range of possible rates of the three examined, ranging from a plan at 4.4 percent of pre-tax income to one at 16 percent.
The marketplace isn’t simple, or quick, but it does provide a significant number of options at standardized costs across age and income — the cheapest plans routinely clock in between 4 and 6 percent of pre-tax income, while the highest premium plans hit around 14-16 percent. And despite early technical difficulties, it’s up and running.
And aren’t options what a marketplace is all about?