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Well, after months of political back and forth, website malfunctions, deadlines and delays, the last few people are now signing up for coverage under the Affordable Care Act, at least for this year. Health advocates are already looking ahead to the open enrollment period for 2015, which starts in the fall.
And NPR's Julie Rovner reports there are plenty of ideas out there to make the process work better next time.
JULIE ROVNER, BYLINE: President Obama took what amounted to a victory lap last week, when it became clear that more than seven million people managed to sign up for health insurance during the health law's first official open season.
PRESIDENT BARACK OBAMA: All told, because of this law, millions of our fellow citizens know the economic security of health insurance, who didn't just a few years ago, and that's something to be proud of.
ROVNER: But that's not to say the enrollment process couldn't use some improvement. Among those suggesting ways to help is the consumer group Families USA. It's got a list of 10 specific changes it says could improve outreach and make the overall process easier for people to navigate. Perhaps the best thing about this particular list, says Ron Pollack, the group's executive director...
RON POLLACK: None of these recommendations require legislation from the Congress.
ROVNER: Among the group's proposals are more funding for navigators and other people who can provide in-person individual counseling to help people select and sign up for health plans, along with more education about the availability of financial help for people to pay premiums.
Another proposal has come in various versions. It would create a special new enrollment period right around the time people are filing their taxes. Families USA's Rachel Klein says that would be particularly important for people who are still uninsured at tax time next year.
RACHEL KLEIN: There are a number of people who will find they are subject to a penalty because they did not have insurance in 2014. Those people will have missed the open enroll opportunity for coverage in 2015, and thus they will be subject to two penalties.
ROVNER: One penalty for not having coverage in 2014 and another because they missed the 2015 open season, so they will remain uninsured for that year too. Allowing people to purchase coverage for 2015 at that point could help minimize some of what's sure to be a backlash against the law next spring. Others have recommended that going forward open enrollment should be set to coincide more with tax season. For one thing, that's when most people who are uninsured have extra money to put towards health insurance. For another, says Klein...
KLEIN: That will also enable tax preparers to play a much more significant role in helping people understand their coverage options and helping them get signed up.
ROVNER: Meanwhile, others remain concerned that choosing a health plan simply remains much too difficult a task for the average consumer. Robert Krughoff heads Consumers Checkbook, a Washington D.C.-based nonprofit that publishes ratings on a wide array of services, including health care.
ROBERT KRUGHOFF: People can't figure out is a $200 deductible and a $10,000 out-of-pocket limit better for me than a $2,000 deductible and a $3,000 out-of-pocket limit, and taking into account co-insurance and co-payments and all those things, people just can't do that. Ph.D. economists can't do it.
ROVNER: Consumer Checkbook has for 35 years published a guide to help federal workers choose from the dozens of health insurance options available to them each year. So they decided to see if they could do something similar for the health exchanges. The first thing they realized, he said, is that too many people are choosing plans based on premiums alone.
KRUGHOFF: They would look at a premium that looks like it's going to save them $1500 a year - real great. You run it through, the estimates of out-of-pocket costs, et cetera, and it turns out that plan will cost them $2500 more a year than some other plans. They really shouldn't do it on premium alone.
ROVNER: Comparing deductibles or even metal levels - gold, silver or bronze - gives similarly misleading results, Krughoff says. So he and his staff built a tool that lets people estimate all their health care costs, in a good or a bad year, and see if their doctors are in the plans too - all in about five minutes. So far it's only gotten up and running in Illinois.
But Jillian Phillips, a healthcare navigator with the Campaign for Better Healthcare in Chicago, said she used the tool this year and likes it a lot.
JILLIAN PHILLIPS: It was really helpful because, first of all, it saved me a lot of time, versus having to kind of crunch the numbers and show them what it would add up to be.
ROVNER: Krughoff says it would be cost-prohibitive for his group to try to replicate the tool for all 50 states, or even the 36 states in the federal exchange. But he hopes the federal government might step up and work with them to make sure people don't end up in plans that aren't necessarily the right fit.
Julie Rovner, NPR News, Washington.
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