The ACA Exchanges Can Be Fixed, But They Were Meant To Be Broken
The serious problems surrounding auto-enrollment in the new Affordable Care Act exchanges are just starting to get real attention. The problem isn’t a lack of good solutions though. The real problem is that the exchanges weren’t intended to work well for regular people.
The fundamental problem with insurance exchanges is regular people are really bad at shopping for insurance
If you want to make these private insurance exchanges work better, the first step is acknowledging the entire Democratic message about the ACA making insurance shopping easy and useful for regular people was either profoundly ignorant or purposely deceptive. Expecting regular people to become highly sophisticated and active insurance shoppers was never realistic.
Selecting the right insurance is extremely complicated. Regular people lack the basic health literacy needed to even understand the choices and even if they do they lack the math skills to make proper use of the information. Most people aren’t going to select the best plan for them and we know from Switzerland only a very tiny percent will shop around each year because of the difficulty.
Efforts to make the ACA exchange choices marginally easier to understand or give more information to people is not a real solution. In the Swiss system things are already dramatically more standardized and switching to cheaper policies is still rare.