TPM‘s Dylan Scott looks at the unlikely leading light in the online launch of access to the Affordable Care Act:
Kentucky, with its deeply conservative congressional delegation, might seem like an unlikely place for Obamacare to find success. But Democratic Gov. Steve Beshear saw the law — and a state-built marketplace — as an opportunity to help put the state on a path to greater health.
His state routinely ranks toward the bottom in overall health, and better health coverage is one step toward reversing that norm, he said.
“For us to make a transformational difference, we needed to do something game-changing.” Beshear told TPM in an interview. “The (Affordable Care Act) provided us a tool to do that. It’s succeeded so far beyond our wildest dreams.”
Kentucky has been cited by numerous sources — the Wall Street Journal, NPR, the Advisory Board Company — as among the best of the best marketplaces since its launch. While the federal site has stumbled, Kentucky is being held up as evidence that the marketplace concept can work in practice.
The numbers back it up: more than 26,000 people have enrolled in coverage, more than 50,000 have started applications and more than 300,000 unique visitors have checked out what the marketplace has to offer. For a state with about 625,000 uninsured people, those are promising figures.
President Obama even called Beshear to congratulate him on the exemplary rollout.
How did Kentucky get it right?
Beshear officially created the marketplace, now named kynect, on July 17, 2012, a few weeks after the U.S. Supreme Court upheld the Affordable Care Act. In October 2012, the state hired software developers to build the technological infrastructure behind the marketplace.
Testing was undertaken throughout every step of the process, said Carrie Banahan, kynect’s executive director, and it was crucial because it allowed state officials to identify problems early in the process. She laid out the timeline like this: From January 2013 to March, they developed the system; from April to June, they built it; from July to September, they tested it.
That stands in stark contrast to the picture painted by federal contractors at last week’s hearing on HealthCare.gov, which underwent testing only in the two weeks before launch. They stressed that they wished they had more time to test the marketplace’s functionality.
“It would have been better to have more time,” Andrew Slavitt, group executive vice president at Optum/QSSI, told the committee.
From a design standpoint, Kentucky made the conscious choice to stick to the basics, rather than seeking to blow users away with a state-of-the-art consumer interface. A big part of that was knowing their demographics: A simpler site would make it easer to access for people without broadband Internet access, and the content was written at a sixth-grade reading level so it would be as easy to understand as possible.
“We wanted it to have a branded feel, but that was not the most important part,” said Gwenda Bond, an exchange spokesperson. “The most important part was that it works. I think a lot of people would say that simplicity is good website design.”
“It’s not glitzy, but it’s very efficient,” Banahan added.
The federal government could probably learn a lot about what went right by looking at how Kentucky contracted the job. There is no question that the executive branch needs to address the flawed contracting process that puts cheap labor and parts ahead of quality and reliability – an issue that is certainly not restricted to one very large Web site.