Research Insights

The Research phase of the project produced a variety of insights about the difficulties of health care coverage in general, the challenges consumers bring to the interaction, and how the system contributes to these challenges. The three key insights from this work are summarized and described below:


Health care coverage is complex and expensive.

  • Understanding the trade-offs in order to select the right plan is a big challenge.
  • Insurance is hard, and consumers are not sufficiently informed.
  • The experience is clouded by industry-specific language; various programs, both within and across states, rely on different terminology. Nothing is uniform.
  • “Coverage” represents different things to different people.

Eligibility is a moving target.

  • My situation sometimes changes. Policies themselves also change. As a result, my plan and I often don’t match.
  • Shifting policies are particularly frustrating for people on the border of eligibility

It’s hard to prove eligibility.

  • The source of the information affects its credibility—not all information is equally trustworthy.
  • The “hub” will not be current for many applicants.
  • Some applicants will not have easy access to important personal information like social security numbers, birth certificates, and proof of income.


Big decisions often come at a bad time.

  • Life events mean that coverage needs will change (having a baby, losing a job, getting divorced).
  • These coverage transitions often occur at stressful times in people’s lives—either for the person applying for coverage, or for the person on whose behalf someone is applying.
  • Periods of duress can prejudice important decisions.

People need to be sold before they invest time & money in the enrollment process.

  • People enroll because they expect an immediate benefit, or because they believe there is no alternative.
  • They are particularly concerned about putting in time and effort (and exposing themselves to scrutiny) with no reward in the end.
  • Many people feel that the current public health insurance enrollment process disrespects their time, and they question whether this will really change with the exchange.

Information is not neutral.

  • Some questions are introduced for the purposes of identification, some for the purpose of evaluation, and some for assessing the system, not the individual.
  • Every consumer displays a different degree of sensitivity to these types of questions.
  • The format of the system treats all information as equally neutral, but some questions do, in fact, create more discomfort than others.
  • People react differently to sensitive questions—some withhold information, others reveal too much, and inconsistencies disrupt the outcome.
  • Helping applicants understand why different types of questions are posed will greatly increase levels of comfort and trust in the system.


It takes a great deal of effort to feel heard, supported, and understood.

  • The human experience is missing from the current system.
  • People feel like they have to negotiate, demand, or speak to a supervisor to ensure that their unique situation is taken into account.
  • People feel like their questions are ignored and that the system only talks to them when it wants something.

It requires expertise to get the most out of the system.

  • The system is designed to keep people out (to avoid fraud or abuse and reduce costs), and requires expertise and tenacity to derive the maximum benefit.
  • Those who are savvy or have better access to information or support fare better than naive users.
  • Looking out for yourself is taxing and doesn’t always yield successful results.
  • Health insurance is complicated. The enrollment process is convoluted. Keeping up is really hard.

The system is slow and unresponsive.

  • Even for individuals who want to complete enrollment, the sluggishness of the system gets in the way.
  • People stall-out or drop-off because they lose focus or lack a consistent sense of progress.
  • The process is time-consuming—traveling on buses to offices, phone calls between work breaks, etc.
  • People aren’t clear on where to go or what’s needed.

Boundaries are invisible; tolerances are mysterious.

  • Not all changes in people’s information hold equal weight.
  • It is unclear to consumers which changes will result in a change to their plan.

Trust is one-way.

  • The system asks people to take a leap of faith, but it too needs to exhibit a level of trust—in consumers.
  • When it comes to verification, some voices are trusted more than others.
  • The new exchange needs to find ways to bridge information gaps.

Hand-offs are abrupt.

  • Transitions between agencies, programs, or platforms (online/offline) can feel jarring.
  • The human experience of these transitions catches people off-guard, disorients them, and leaves them feeling abandoned.

Behind-the-scenes complexity has created a gauntlet for consumers to negotiate.

  • Stakeholders hope that enrollment will ensure that people are in the right programs and that no one is abusing the system.
  • One attempt to ensure program integrity is to make consumers jump through hoops—this often makes them lean on assisters for support in navigating complexity.


Posted in: Strategy