- The Washington Times - Sunday, May 25, 2014

When it comes to providing health care, following the Amazon.com model turns out to have been a good idea.

With the first round of Obamacare enrollment in the books, states that set up their own exchanges and allowed consumers to browse “anonymously” — looking at plans and costs without having to enter a lot of personal information — seem to have done just fine.

Heading into enrollment, not everyone was sure that would be the case.

The federal government followed a different model, requiring would-be customers to reveal all of their personal details up front in order to see what sorts of plans they would qualify for, and how much the plans might cost.

But some states went the other route, deciding customers used to buying online from Amazon.com or eBay are accustomed to browsing before buying, without first having to turn over personal information before they’ve made the decision to buy.

“Quite frankly, I was on the wrong side of history on that debate, because I argued against anonymous browsing,” said Wade Horn, a director at Deloitte Consulting, which launched several state-run exchanges. “Because my feeling was, ‘Hey look, you know, they go there and they’re going to see prices on a health plan that may not actually represent what the actual price will be at the end, because of the subsidy, and so that’s going to be confusing.’”

But “cooler heads” won the day, he said, and exchange websites that went with the anonymous browsing model worked out well. The states that relied on Deloitte for their state-run exchange’s IT needs — Connecticut, Kentucky, Rhode Island and Washington State — have been held up as relative success stories amid the horror stories from other states from the troubled launch of Obamacare last fall.

Each of Deloitte’s exchanges used an anonymous shopping tool that allowed users to enter general information such as family size and ZIP code, giving them an estimated cost of coverage before their subsidy was verified by the government.

“Many people want an idea of what they may qualify for before committing to the application process,” said Gwenda Bond, a spokeswoman for Kentucky’s exchange, known as “kynect.”

Health analysts said this hybrid model is ideal, because it lets consumers click around exploring plans, while offering just enough information about themselves to get an estimated price. The verified amount will have to come later, after more detailed information is processed through Obamacare’s federal data hub.

It’s kind of like shopping online — the price is known when you put items in the shopping cart, but “you don’t know taxes, shipping and all that, usually, until you get to the checkout process,” said Elizabeth Carpenter, a director at the Avalere Health consultancy in Washington.

Federal officials said they had hoped to allow anonymous browsing, but didn’t have that part of the website ready by Oct. 1, the day the federal website went live.

Instead, HealthCare.gov, which served 36 states, forced users to register and enter extensive personal information first, causing a bottleneck when many consumers tried to log in at once — leading to the now-infamous crashes and delays.

“We had always envisioned window-shopping as a tool that would be a part of HealthCare.gov at some point, however we chose to prioritize other functionality in order to be ready for an Oct. 1 launch, and added this tool for consumers in early December,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services.

Critics, though, say the administration scuttled the anonymous browsing tool because they were afraid consumers would get sticker shock and give up on trying to enroll before learning how much in Obamacare subsidies they might qualify for.

“They made a decision that was more political than it was the kind of business decision Amazon.com would have made,” said Robert Laszewski, a health policy consultant in Alexandria, Virginia.

Other states have taken note of the success of the anonymous browsing model.

After its site was plagued with glitches, Maryland has decided to embrace the concept for the next round of enrollments.

“The rationale for not allowing anonymous browsing was to make sure people could see the actual prices of plans that would pertain to them, rather than an estimate,” said Alison E. Walker, spokeswoman for the Maryland Health Connection. “The technical issues we experienced precluded adding this feature to the website.”

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