In October, state health insurance exchanges (HIX) will start enrolling Americans for coverage as required by the Affordable Care Act (ACA). That’s good news for people with computers and broadband connections, who should have an easy time accessing state exchange portals to compare offerings, determine eligibility, enroll in plans and pay premiums.
But many who rely on smartphones for Internet access will have to choose a different way to apply for coverage, at least this year.
“We did have an extensive discussion around mobility and mobile access to our exchange early on,” said Curtis Kwak, CIO of the Washington Health Benefit Exchange. “Because the timeline was engraved in concrete for Oct. 1, we didn’t get a chance to build that into our version one application. But it’s definitely queued up for version two, which is planned for an August 2014 launch.”
State leaders understand that smartphones play an important role as Internet access tools, but in the scramble to get their HIXes up and running by October, most states haven’t yet tackled the question of mobile access.
But smartphone use for Internet access is particularly high among some of the groups most likely to look to HIXes for health coverage because they aren’t getting it through employers.
Of adults who use their cellphones to access the Internet, 45 percent of 18- to 29-year-olds, 51 percent of African Americans and 42 percent of Latinos do most of their online browsing that way, according to the Pew Research Center’s Internet & American Life Project. People in households that earn less than $50,000 a year and people who haven’t graduated from college also are likelier to rely on mobile phones to get online, Pew said.
“[States] are finding themselves behind the eight ball as far as being ready for the exchanges. So they’re not as focused on the newer technology,” said Jinnifer Wattum, director of eligibility and exchange solutions for Xerox Government Healthcare Solutions.
People who lack Internet access will be able to interact with HIXes in other ways like calling customer service centers or mailing paper forms. And smartphone users won’t be entirely out of luck either.
Citizens will be able to use their mobile phones to read material on state exchange portals and perhaps to conduct some transactions. But which functions they can use, and how easily, will vary by state.
Watch video (above): Massachusetts' Health Insurance Exchange Focuses on Reusability
“The good news is that the health benefit exchange interface is not a very heavy interface,” said Manu Tandon, secretariat CIO at the Massachusetts Executive Office of Health and Human Services. “Our idea in general is to make the amount of information we ask of citizens, especially if we’re asking the second time around, as minimal as possible.”
The Massachusetts HIX interface will contain a minimal number of data fields, Tandon said. It could become even simpler as the state’s system starts to pull more data from a hub that the federal government is building to supply data to state exchanges in real time.
If citizens don’t need to enter a lot of information, they might be able to conduct transactions through the browsers on their smartphones, he said.
Massachusetts comes to the ACA with a strong advantage: Most of its residents already have health insurance, thanks to legislation the state enacted in 2006. When its new ACA-compliant HIX opens for business, most residents will use it to renew or change their coverage, not to enroll for the first time, Tandon said. Massachusetts will need to collect less data than typical states, so more residents will be able to use their smartphones to complete the tasks.
But in most other states, residents seeking health coverage will need to complete a lengthy form. The “streamlined application” — a single form used to apply for Medicaid, the Children’s Health Insurance Program and health insurance plans offered on state exchanges — is complex, said Bruce Caswell, president and general manager of health services at Maximus, a Reston, Va.-based company that partners with local governments to provide health services for poor communities. “That might not make it suitable to be completed on a mobile device.”
So what will Americans be able to do on their smartphones when HIXes open in October?
Nevada Targets Tablets
Smartphones aren’t the only mobile devices citizens can use to access state health insurance exchanges. Nevada is working to accommodate tablet computer users to interact with its Silver State Health Insurance Exchange.
"Tablets have a screen size that will allow for the comparison of plans side by side, and all the things that go along with the plan,” said C.J. Bawden, communications officer of the Silver State Health Insurance Exchange. The much smaller screens on smartphones don’t easily allow for that kind of activity.
Nevada is designing its exchange’s interface to display well on standard computers and tablets, Bawden said. ”We are going to move forward into development of an app or development of a mobile site, in future years, to make it easier for a person with a tablet to walk through all of the steps.”
In the exchange’s early years, Nevada will analyze how long it takes to navigate the site and where users encounter problems to improve the site across various devices.
Tablets could also become an important tool for navigators, or people who, under provisions of the Affordable Care Act, will educate individuals and small employers about health plans and help qualified individuals enroll. In Nevada, many of the navigators who guide citizens through the exchanges carry tablets, Bawden said.
Bruce Caswell, president and general manager of health services at Maximus in Reston, Va., said that navigators might become the real force driving adoption of mobile technology for health insurance exchanges.
"”I think that an iPad or tablet-based, downloadable app that individuals in the field can use in a comfortable setting to educate, communicate and then help navigate the process is going to be critical,” he said.
In states like Nevada, where vast areas of sparsely populated territory lack broadband and wireless service, navigators who visit residents during open enrollment periods might need other mobile technologies as well, said Bawden. ”We’re looking at putting together a truly mobile system, possibly with a vehicle with a satellite uplink to drive out to these remote locations.”
Photo of Manu Tandon by David Kidd