The Stupid People Problem: Healthcare Apps for Old People

The insurance companies have finally started talking about the fact that it is probably cheaper to retain existing customers than recruit new ones. Since there is not much that differentiates one insurance company from another, one policy from another, they have recognized that treating people better might be a good way to keep their customers, or so they say.  

I was at a conference participating in a panel about customer retention.  The woman on the panel with me was there to speak about her project.  She had been hired by the Big Blue Insurance companies to develop healthcare applications for the phone. 

When it came her time to talk, she was so excited.  We were excited.  Everyone is interested in app development.  What new thing was she going to show us?  It turns out the insurance companies had allocated 10s of millions of dollars to develop apps for old people. Yes, you read this correctly.  Seniors were going to be given, for free, apps in order to communicate with their insurance companies and manage their healthcare.  

Many in the audience smiled and nodded, listening intently to the presentation.   The idea seemed rather simple, old people would download apps on their phone and use them to manage their pre-approval process for an upcoming surgery and/or to check things like: Is my doctor a preferred provider? I need a specialist, who accepts my plan?  Why is my doctor billing me for services that I thought were covered?   It would cost millions, but in the end customers would be happy.

To me, it seemed like a bad joke.   Did she really believe my 90 year old father would use his phone to manage his healthcare? Was the concept really that the elderly parents and grandparents of people attending the conference, when in need of help, would rather use their phone than talk to a human being? 

I asked her if there would be some training, how to use the phone and how to use the apps? She looked at me as if I was an insane person who had six heads, each of which had fire shooting out of them, with snakes and pink glitter. She took a long pause and then let me know in no uncertain terms that everyone, yes, everyone, knows how to use apps!  

I was thinking about every person I knew who got calls from their parents asking for help with using their computers; asking them how to set up their answering system on their phones; asking them how to text; asking them how to take, open and forward pictures to their friends.   I was thinking about every child someone I knew whose parents had asked them for help using their phone, asking them some of the same questions that they had been asked by their parents.   I was shocked at the response.  When I took out my flip phone to show it to her, she just glared at me.

Someone else asked her whether or not the apps would be available in large print.  We then saw the same look of incredulity and condescension directed at the person acting the question.  Then came the response;  since everyone already uses apps on their phone there’s no need to make any changes to accommodate larger print other than what phone software already made available.  Old people don’t need things in larger print.

No more questions were asked.  There was lots of applause.  Many of the people from the insurance companies funding this project congratulated her on her excellent presentation. 

When I speak to people over the age of 65 and tell them that the insurance companies are spending millions developing phone apps for them, after the laughter stops, they are curious.  They want to know what it would do that might remotely be of interest to them.   They get very concerned that insurance companies will no longer allow them to speak to a person when they have a questions.  The one response I get almost every time I speak to someone is “Couldn’t they spend those millions of dollars on increasing my benefits?” followed by something like “maybe they could pay for the anesthesia when I get my colonoscopy?” or some equivalent comment about a benefit that they would like to have. In fact, the reaction of people over 65 is remarkably similar to the reaction of the people over 35.  It is the people under 30 who are interested in what the app will do and when they find out they will only be using it if they get sick and use their insurance, they lose interest.

The “Stupid People Problem” is not about stupid people. It’s about very smart people acting like they are idiots.  The division between reality and this woman’s perception of reality was striking. She had no clue about the appetite of older people to learn and embrace new technology, and no clue about the technological aptitudes and abilities of older people.  Nor was she willing to consider that her perception that all people are technologically proficient might be misguided.   Even worse, she failed to consider that older people access the healthcare system when they are sick, often facing the end of their life. Learning how to master an application on their phone is not high on their list of priorities. 

Not only is her inability to think outside her box striking, but it is also amazing to me that the insurance company senior executives that approved this multi-million dollar budget also did not consider these factors.  Can’t you picture the meeting?  “Apps for old people, Yeah, that’s a great idea!  They all are tech savvy already and we could probably save money on phone support for those people.  It will save us millions.”  It could be worse.  The discussion might have been “Great idea!  That will make it harder for older people to access their healthcare benefits.  We will be able to reduce service and save money because we will make them use the apps, deny them access to phone for approvals, and eliminate costs in customer support!”

Maybe they aren’t so stupid after all.

To Insure or Not to Insure? That is the Question!

Lacking health insurance does not necessarily mean you will have to pay a fine.

Under the Affordable Care Act, United States citizens and certain legal residents are required to either obtain health insurance or pay a penalty. That penalty is the greater of two amounts: a flat dollar penalty for each uninsured adult, which will rise from $95 in 2014 to $695 in 2016; or a percentage of a household’s adjusted gross income in excess of the threshold for mandatory tax-filing.  The percentage will be 1.0 percent in 2014 and then rise to 2.5 percent in 2016 and subsequent years (also subject to a cap).

Most Americans who do not have health insurance will not have to pay the penalty for being uninsured.  This is because they fall into one or more of the exempted categories , including:

  • Unauthorized immigrants, who are prohibited from receiving almost all Medicaid benefits and all subsidies through the insurance exchanges;
  • People with income low enough that they are not required to file an income tax return;
  • People who have income below 138 percent of the federal poverty guidelines (commonly referred to as the federal poverty level) and are ineligible for Medicaid because the state in which they reside has not expanded eligibility by 2016 under the option provided in the ACA;
  • People whose premium exceeds a specified share of their income (8 percent in 2014 and indexed over time); and
  • People who are incarcerated or are members of Indian tribes.

The Congressional Budget Office working in conjunction with the Joint Committee on Taxation have concluded that of the 30 million Americans estimated to be uninsured by 2016, 23 million people will qualify for one or more of those exemptions. Of the remaining 7 million uninsured people, about 3 million people will be granted exemptions from the penalty because of hardship or for other reasons.  This leaves about 4 million people who could be subject to paying a penalty.  However, this 4 million figure is actually less because it includes uninsured dependents of parents who will pay the penalty on their behalf.

The good news is that the government estimates that 2 million less people are projected to pay the penalty than was originally projected in September 2012.   The bad news is that the decrease in the number of people who are projected to pay the penalty largely stems from an increase in the number of people who will be exempt from paying the penalty; not from a rise in the number of people anticipated to be covered by insurance.

Rev. Proc. 2014-30 – Health Savings Account Maximums for 2015

This revenue procedure provides the 2015 inflation adjusted amounts for Health Savings Accounts (HSAs) as determined under § 223 of the Internal Revenue Code.

Annual contribution limitation. For calendar year 2015, the annual limitation on deductions under § 223(b)(2)(A) for an individual with self-only coverage under a high deductible health plan is $3,350. For calendar year 2015, the annual limitation on deductions under § 223(b)(2)(B) for an individual with family coverage under a high
deductible health plan is $6,650.  High deductible health plan. For calendar year 2015, a “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not
premiums) do not exceed $6,450 for self-only coverage or $12,900 for family coverage.

This revenue procedure is effective for calendar year 2015.