Simplifying health care
As a central part of President Barack Obama’s health-care law, Americans will soon be able to obtain insurance through federal exchanges. But how, exactly, will people apply for coverage? In March, a draft of the administration’s application form was released online. Unfortunately, the form was complex, long and immensely difficult to navigate. Skeptics asked a reasonable question: How can the law possibly work, if people can’t understand the forms they need to fill out to get insurance in the first place? Last week, the Department of Health and Human Services released a radically revised application form, and there’s excellent news. It’s much simpler. For single people, it consists of just five pages — and only two of those pages have a lot of questions on them. The form shouldn’t take much more than five minutes to fill out. An online option should be faster still. For people with families, the form is a bit longer (11 pages), yet the questions are straightforward, simple and jargon-free. Remarkably, the new federal applications compare favorably with those used by the private sector, which has an economic incentive to make it easy for people to enroll.Although the tale of the streamlined insurance application form has a happy ending, it also offers three general lessons. The first lesson is that complex forms and requirements can seriously undermine federal and state programs. Consider the Free Application for Federal Student Aid, completed by 14 million households every year. The Fafsa, as it is called, includes more than 100 questions. It is almost as long as the Internal Revenue Service’s Form 1040. Evidence demonstrates that the student-aid form has had a substantial, negative effect on college attendance, merely because it is so difficult to complete. In fact, a simplified process for receiving federal aid has been shown to produce a large increase in college attendance — comparable to the increase that would be produced by giving applicants several thousand additional dollars in aid. Fortunately, the federal government has taken steps to fix the problem. Recent efforts to reduce the complexity of the Fafsa are having a major impact. Application forms may seem like a trivial matter, but complexity can make it less likely that small businesses will be able to get loans, that developers will be able to obtain permits, that poor children will qualify for free meals, and that citizens will understand (and comply with) the law. Complexity can also impose significant costs — as reflected in the stunning fact that Americans spend more than 9 billion hours on federal paperwork requirements every year. The second lesson is that federal forms should be carefully tested in advance, to ensure that people can understand them and to ferret out undue complexity. Have you ever visited a new town and asked a local how to get to the nearest gas station? You might well receive incomprehensible instructions, ending with a terrifying phrase: “You can’t miss it!” Regulators can be a lot like that. Those who produce federal forms tend to be specialists, and they have no trouble understanding what they produce. All too often, they fail to gauge whether ordinary people will also be able to understand them. The results can include unnecessary complexity, confusion and frustration. In testing the forms, there is no substitute for asking people to fill them out and learning whether the paperwork is simple and navigable. The third lesson is that with respect to the health-care law, what matters is people’s actual experience, not the length and detail of underlying law. Many critics of the law note it is 905 pages, full of detail and jargon. Isn’t that a horrible problem? Not necessarily. Consider modern smartphones and tablets. The underlying technology is far from simple. On the contrary, it is so complex that it could have been barely imagined as recently as a decade ago. A lot of pages went into its creation. For consumers, however, the underlying complexity doesn’t much matter, because the user’s experience is easy and intuitive. Even small children can use iPads. True, Obama’s health-care law isn’t exactly an iPad, but it can be carried out in a way that minimizes confusion and complexity. There is a very long way to go. Last week’s announcement was a big step in the right direction.
Cass R. Sunstein, the Robert Walmsley University Professor at Harvard Law School, is a Bloomberg View columnist. He is the former administrator of the White House Office of Information and Regulatory Affairs.
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