Why HealthSherpa.com is not a replacement for Healthcare.gov [UPDATED]

UPDATE: In June 2014, Ning Liang, one of the founders of HealthSherpa, wrote in about updates to the site. Ling said that they can now enroll people in ACA marketplace plans, including subsidies. According to Liang, “we are the only place besides Healthcare.gov where this is possible. We have signed an agreement with CMS as a web based entity to do this. We are directly integrated with the federal data hub, so going through us is identical to going through Healthcare.gov.”

Earlier tonight, Levick director of digital content Simon Owens discovered HealthSherpa.com, thought it was cool, and read a Daily Dot post about it that framed it as 3 20-something San Francisco Bay-area resident coding up an alternative to Healthcare.gov.

Could it be that easy, wondered Owens? Could these young coders have created a simpler, better way to shop for health insurance than the troubled Healthcare.gov?

healthsherpa

Well, yes and no. As is so often the case, it’s not quite that simple, for several reasons.

1) As always, note the disclaimer at the bottom of HealthSherpa.com: “The information provided here is for research purposes. Make sure to verify premiums and subsidies on your state exchange or healthcare.gov, or directly with the insurance company or an agent.”

Why? The site is based upon the publicly available data published by the Department for Health and Human Services, individual state exchanges and Healthcare.gov for premium costs, like this dataset of premiums by county at data.healthcare.gov.

Unfortunately, there appear to be data quality issues, as CBS News reported, that may be an issue on both sites.

When I compared searches for the same zipcode in Florida for a 35 year old, single non-smoking male, I found the same 106 plans but was quoted different premiums: $128.85 on HC.gov vs $150.24 on HealthSherpa. Hmm.

That could be user error, but… it looks like Healthcare.gov continues to underestimate costs.

Healthsherpa may actually be doing better, here. Good job, guys.

2) Regardless, this is not a replacement for everything Healthcare.gov is supposed to do.

The federal and state exchanges aren’t just about browsing plans and comparing premiums for options in a given zipcode in the “marketplace.” After a user knows decides which plan he or she want, the software is supposed to:

1) Register them as a user (registration was up front initially, which was a controversial, important choice, relevant to the site crashing at launch)
2) Authenticate them against government data bases
3) Verify income against government data bases
4) Calculate relevant subsidies, based upon income
5) Guide them through the application process
6) Send that form data on to insurance companies for enrollment.

The tech that underpins the test and graphics website on the front end of those process continues to hold up well.

The rest of the software that is supposed to enable visitors to go through steps 1-6 software, not so much. 16 state exchanges and DC are having varying degrees of success, with HHS Secretary Kathleen Sebelius acknowledging issues with data quality in Step 6 in her testimony to Congress.

3) While it has a subsidy calculator, otherwise Healthsherpa doesn’t replace Healthcare.gov.

Healthsherpa enables you to find a relevant plan and then gives you contact info for the relevant insurer.

For instance:

“Call Humana Medical Plan, Inc. at (800) 448-6262.
Use their menu or ask the operator to speak to someone about purchasing coverage.
Tell them you would like to purchase health exchange coverage, specifically the Humana Connect Basic 6350/6350 Plan for Hillsborough County, FL.
Follow their instructions to complete the application process.”

It does not place calls to the data hub to calculate steps 1-6.

That limited functionality, however, has been good enough for U.S. Senator Angus King to recommend HealthSherpa as a temporary alternative to Healthcare.gov.

“HealthSherpa offers a user-friendly platform to quickly browse through available health insurance plan options, including monthly premium costs, coverage plans, and possible premium subsidies,” Senator King said. “I recommend that Mainers who are having trouble with Healthcare.gov use HealthSherpa as a temporary alternative until the federal website functions properly.”

4) There are OTHER private healthcare insurance brokers that could be doing this.

Back in May 2013, the Center for Medicare and Medicaid Services issued official guidance for private sector brokers in online health insurance marketplaces. (PDF)

Former U.S. chief technology officer Aneesh Chopra said that these “Web-based entities” will be online this fall, operated by entities like eHealthInsurance.com and GetInsured.

For some reason, however, private sector insurance brokers have been stymied by the federal government from selling ACA insurance policies.

That’s unfortunate, given that the Obama administration could use a Plan B, just in case the progress on Healthcare.gov doesn’t lead to a functional federal health insurance exchange twenty days from now.

Update: Jonathan Cohn, writing for the New Republic, looked into Healthcare.gov’s backup plan and comes up with an interesting detail: issues with the so-called data hub could be holding back deployment of private online health insurance brokers.

…administration officials have been huddling with insurers about how to make more use of direct enrollment. Step one is to make sure that “side door” enrollment works smoothly. It doesn’t function well right now, because—you guessed it—it relies on the same information technology system that powers healthcare.gov. Fixing that portal, which techies tell me is called an “application programming interface,” is high on the administration’s to-do list. But it’s not clear (to me) whether improving the portal might require design modifications—or to what extent its success depends upon other, ongoing repairs to the federal website.

So, here’s some speculation: While it’s hard to know for sure, but it’s quite likely that that “portal” is the data hub that’s behind Healthcare.gov, and that it may not be up to additional volume from private sector demand.

The federal exchange and state exchanges both rely upon it, and, while federal officials have said that it’s working, a report by the New York Times yesterday that some state health insurance exchange are continuing to battle tech problems indicated that it’s not holding up under demand:

Even states whose websites are working well say they are hampered by a common problem: the federal website, particularly the data hub that checks every applicant’s identity and eligibility. That hub has stopped working on several occasions, preventing applications in the states from being completed.

If that’s happening now, concerns about the ability of the hub to hold up under the pressure of private sector online insurance brokers could well be justified. If I learn anything more definitive, I’ll share it.

19 thoughts on “Why HealthSherpa.com is not a replacement for Healthcare.gov [UPDATED]

  1. The Health Sherpa is calibrated for individual ages in a way that healthcare.gov estimates are not. I have compared the Health Sherpa estimates for Wake County NC with 28 quotes directly from the two insurance companies for my family and all are accurate +/- 2 cents.

  2. I am just amazed at the lack of news or pundit coverage of the HealthSherpa.com website. It’s almost as if there was a news black out on this. I watched a 10 minute in depth discussion on IT issues with the healthcare.gov website on MSNBC with not a mention of the HealthSherpa.com site and how close it is to solving major issues with the Affordable Care Act (ACA) and dispelling many of the myths and misconceptions being spewed endlessly throughout Congress and by the pundits with endless news cycle coverage by the media.

    The beauty of the HealthSherpa website is that it allows an individual to see the array of policies and prices available within a minute or two. People can immediately see that for example they will only have to pay $250/mo. for a decent policy instead of $450-$500/mo. they are currently being charged a defective policy with all kinds of critical limitation.

    Instead of being dismayed and frantic that President Obama lied to me and my insurance company sent me a cancellation letter saying they would no longer allow me to keep my defective policy — I am overjoyed that I will be able to obtain a good replacement policy for half the cost and without critical limitation.

    If I want to get the policy I can contact the insurance company directly and obtain it. Healthcare.gov will be fixed eventually, but people need to know NOW what they can obtain and for what cost — HealthSherpa does that and the 3 young guys who developed it have done a huge public service in setting up the site (Thank you!).

    One would think that such a huge development on this highly controversial issue would deserve some media and pundit attention. What’s up with that??

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  4. I can see where they get their data from healthcare.gov, but where do they get their data for each of the state exchanges and for ‘off exchange ‘policies? Anyone know where to find these?

  5. From talking to people that have wrestled with the government site it appears the back end is what is called an “out of wallet” id verification. They appear to be using Equifax for this (nice bundle of cash for Equifax). The credit bureaus now have income estimator/verifier options, so they maybe using that service as well, although one would think if you owned the IRS you wouldn’t need that service.

    I am in the credit approval business and we do this stuff all the time for financial companies. It’s not really that hard, and it would not be hard to add it to the sherpa site.

    I would say the idiots in Washington would be far better served if they admitted they picked the wrong people to build their site and threw a pile of cash at the sherpa guys and said replace the whole thing.

  6. The data on data.healthcare.gov only provides rates for 21,27,30,40,50, and 60 year olds. How did Sherpa calculate the rates for the other ages without rate tables?

  7. Really great article. I’m interested in understanding a little more about the data sources. It seems plan information can be easily accessed on the national marketplace. What about states that are running their own marketplace, where are companies getting that data from? Is there a central data source for all health insurance plans across exchanges?

  8. I was surprised when the overflow of calls for the Maryland Health Exchange went to a call center in Arizona who was staffed by United Health Care personal who would take in call data and sell it to agents in those states.

    In essence , tax payers paid for a website and a then their contact information was collected and sold unknowingly .The state thought this was a good fix for their understaffing problems.

    Many on my now clients who called the state exchange directly , thought they were talking to a state exchange employee , completely unaware their calls were high jacked to a third party.

    Many thought they had enrolled and then after a month or so contacted an authorized agent like myself for help. Some missed the deadlines altogether .

    Most of the rates I saw from Health Sherpa were correct, However, in some cases the subsidies were they grossly over estimated so that the buyer would think they were getting a bigger discount .

    Don’t know if this was intentionally , but no harm was done as the net seemed close to the actual cost.

    Health Sherpa was helpful at the beginning when most of the state rates were offline.

    The Feds could have outsourced this whole mess to third parties like eHealth.com who have thousands of agents like me who were ready to help.

    In my opinion , this whole debacle was not so much about helping those who wanted to purchase affordable health care , but was used as a tool to expand the new welfare nation by explaining Medicaid .

    I lot of good will come from this at a huge cost to the taxpayer.

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  10. I have a question for HealthSherpa:
    Our agents have been enrolling direct with the FFM- nervous about EMO’s/Digital utilities for a variety of reasons. Yes, we struggle with identity verification sometimes. Yes, we struggle with account access and creation. As the largest individual firm in WI, we don’t mind the cost per application. However, how does it work if next year they call in directly to the Marketplace and enroll? how does healthcare.gov communicate that to health Sherpa, how long does it take?
    What happens to my clients if the FEDS come down and disallows these type of non-verified enrollments from third parties and lastly, is this for on and off exchange? Our firm focusses on WI, NV, and IL. individuals on Medicare and needing an ACA plan. For on-Exchange individuals (ACA is my department), using the FFM- can you explain the streamline of info to healthcare.gov, then to the insurer, and does this utility help select the PCP for certain plans on the app? thank you. feel free to email me as well, JJ@insuredbyjj.com

    • Hey folks, figure an update is in order since this is still one of the top Google results for our name:

      Since we started HealthSherpa two years ago, we have become a licensed health insurance agent in all 50 states, and have continued developing our technology and human support services to help make enrollment in ACA-compliant health insurance easier than ever. We have made over 350,000 enrollments through date, and expect to hit 1 million lives enrolled at some point in 2016.

      We now have partnerships with nonprofits such as Enroll America and consumer education portals like NerdWallet, as well as dozens of companies. We’re the enrollment tool of choice for over 10,000 FFM agents and provide several tools to make agent’s and carriers life easier, and their time more productive.

      Whether you’re an individual or an agent, we’d love to help you as we expand on our mission to help every American feel the comfort and security of having health coverage.

    • JJ – we’re now working with over 10,000 FFM agents across the country, and are signing up several hundred every week during this OEP. We’ve also lowered our per-application fees for individual agents to $10, with some options for discounts (e.g. referrals).

      We have a good working relationship with the relevant authorities. If something were to happen to our business, all your applications submitted through us are also logged into the FFM on the spot, so your existing business would not be affected.

      Will reach out to your e-mail, and feel free to reach out to us at agent_support@healthsherpa.com

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