HealthCare.gov Compares Insurers With Little Evidence That It Works

As further testimony to the current Administration's commitment to force those dastardly commercial health insurers out from under their rocks into the cleansing light of righteous Obamacare, the "health care dot gov" web site has posted all the nation's commercial insurers' pricing and application rejection rates. Input your state of residence, marital status (single, married, children), whether you've been rejected for coverage, age, overall health status, employment situation, and zip code and [poof!] the site will generate (when the Disease Management Care Blog took it for a test drive) several pages of options with varying deductibles, co-pays and premiums.

All well and good, says the DMCB, until it thinks about the evidence that this will work as intended. For consumers who are lucky enough to fall on the more affluent side of the digital divide and have a choice of media, only a minority actually use the internet to shop for health insurance. The DMCB could find no published research on the topic of it changing purchasing behavior, which is ironic, given our federal infatuation with comparative effectiveness research.

Research on internet-based ratings of hospitals has shown internet-based comparisons are not the slam dunk that many assume they are. The ratings are subject to variable methodologies (an issue for healthcare.gov that was already raised by AHIP) that can "confuse, rather than inform consumers," or may not tell the whole story, or simply get it wrong. The surfing public may not reward "better" entrants with increased market share and one reason may be because users don't find the information helpful. Even CMS's own web site that compares hospital quality isn't really all that.

While the insurer compare site may have given the Obama Administration some positive news media attention, (aided by AHIP's needless push back) the DMCB doubts it will ultimately have much of a material impact - based on the current evidence - on the purchasing behavior of consumers of health insurance. To go about this right, HHS should measure "hit" rates and conduct user-surveys to see how it's going. If the data are disappointing, hopefully they'll have the courage to take down the site and announce its demise with the same fanfare that accompanied its start.

Somehow, the DMCB thinks that is unlikely.