Yesterday, I took my first stab at browsing the NY healthcare exchange website. Unlike many states, NY set up it's own healthcare exchange at https://nystateofhealth.ny.gov/. So this is NY's version of "Obamacare", and NY residents use this website for enrolling in mandated insurance plans, rather than using the now-infamous 'healthcare.gov'.
So I went through entering all my personal information, family information and verifying my identity. Then i started browsing the many, many plans open to me based on the information I entered. I had just started browsing and was not ready to purchase anything at this point. I just clicked through the first plan to try to look at what kind of things would come up about the details of each plan.
To this point, the site had never asked me about my income or raised the issue of subsidies - a central feature of Obamacare for which most people will be eligible. And the premiums for all the plans that came up after I'd entered the personal info were much higher than what I was expecting. So I assumed that it must be that the issue of subsidies will come up at some point as i click through the details of an individual plan.
Nope. Instead, as I clicked through the screens of the first plan I was browsing I suddenly found that I'd agreed to buy that plan. Nothing about income ever came up. Nothing about subsidies ever came up. I used the 'chat' feature to speak with someone for help, and sure enough I'd enrolled in that plan and could not change it. I'd have to call on Monday to try to unenroll.
Shocked, I then asked where on the site does the issue of income or subsidies come up. And the chat person told me that in one of the early pages of the personal info forms, and before you see any of the price tags, there's a question with a tick-box that says:
"Do you need help paying for your health insurance?"
As I was just browsing through entering personal info at this point i didn't really notice this tick-box or realize how crucial it was, and did not click it. But if you do not tick this box, the website never asks you about your income, and never mentions anything about subsidies. Only if you tick that box does any of this ever come up.
This strikes me as highly misleading in several ways. First, it is not up to me whether I "need help". The law determines whether I get a subsidy or not, based on my income situation. Their design of the website puts the burden - shifts the burden I'd say - onto each individual to know that subsidies exist, to know that they're eligible for them, and to proactively ask to receive them by declaring they "need help" at the outset.
Second, framing the subsidies as "needing help" is also manipulative in my opinion. The subsidies in Obamacare are unlike almost any other kind of government "help" or public assistance. For most people eligible for a health insurance subsidy under Obamacare, these are people that never get government "help" for paying for anything else. And of course unless people have followed the ins and outs of this very complex law they would not even know that they are in fact - like most people - eligible for some kind of subsidy ("need help").
Many people have a natural aversion to asking for "help" in the first place. And many people would not even know they are entitled to it under this law.
Rather than informing people about the subsidies, the design of the NY exchange site puts the burden on each user to first declare that they "need help" paying for health insurance. In effect, it's kind of like asking each person to declare that they need "welfare" or "government assistance", rather than informing them that they are entitled to a subsidy under the law. Recall that the subsidies are a crucial part of the deal here with Obamacare. We're now being forced to buy a product that we may not even want, but a crucial trade-off built into the law is that the government is going to help most people pay for it. And most people eligible for these subsidies are never eligible for any other kind of government "help" in paying bills in any other context.
So I - like I expect many people - did not notice this box. I then wound up seeing price tags much higher than I was anticipating. But that's only because I follow sites like Kos and know about the subsidies, know that I do qualify for it and know to look for it. This led me to keep clicking through the screens thinking I'd eventually come up to the subsidy part of the application, but by doing so I then wound up inadvertently buying a plan with no subsidy.
But what about other people who are less informed about the subsidies than I am? Would they even realize that something was missing here? Would they realize that these premiums being offered were way too high? I almost think that NY state is hoping that many people out there won't even realize any of this, and will just assume that this is what they have to pay now, and will effectively lose their subsidy because they did not realize how crucial was that early "I need help" tick box on the website.
To me, this seems like a site designed and worded in such a way as to trick many people out of receiving their subsidies and that NY state needs to be called on it.