The Inclusionist vs. The Affordable Care Act

A few months ago, the instructor of a user design workshop challenged the class to redraft the Healthcare.gov website, the official site of the Affordable Care Act.

In a flash, my 23-year old classmate and team member, Sam, deftly sketched out a new landing page and a few forms. We had time left over to chat. It was Sam’s chance to question the very existence of the site itself.

Sam complained that the Affordable Care Act seemed neither affordable nor about care. As a healthy freelancer he would be soon forced to purchase an expensive financial product – health insurance. And a quick search informed him that if he did not comply he could plan on spending $695 to opt out. Sam turned to me and said, “I don’t know where to begin.”

Projected to cost $1.36 trillion dollars by 2023, the Affordable Care Act is one of the biggest financial inclusion experiments in the world. It requires that every resident of the U.S. participate in a financial scheme to purchase health insurance.

In making the product fully inclusive, U.S. President Barack Obama and proponents of the bill could have followed the advice of many of the financial education skeptics I call “inclusionists”: The inclusionists dismiss high touch financial education as a key part of financial inclusion. The arguments against high touch education run thus.

• Going digital is the answer – face-to-face is too expensive. As it turns out, proponents of the bill soon realized that they would exclude the very people they hoped to include if they did not have an analog component. Sam himself a “young digital” went back to his home state to get face-to-face help from two of the many publicly-funded “navigators” and “assisters”, i.e. financial education service providers.

• Make the interface intuitive – users will figure it out, after all they are capable. The problem with this approach is that even if the interface is intuitive, the product may not be intuitive. Sam is an example. He understood the interface, even fixed it to his liking, but for him the product was inscrutable.

• Education is a marketing problem. Suppliers stand to gain from more customers and thus should bear the burden of reaching more. But, imagine the confusion if suppliers alone were in charge of educating the U.S. public on their insurance options? Chaos would ensue. Suppliers are self-interested in promoting their own products.

Instead of falling for the arguments of the inclusionists, proponents of the Affordable Care Act allocated hundreds of millions to educate people like Sam and those who are far poorer and less literate.

Affordable Care has multiple forms of high tech and high touch points of access, countless opportunities to seek face-to-face support, and a wide range of payment options, all bound up with community activism, public education, and presidential comedy. Yes, my president is pushing financial inclusion as humor. He is not relying on intuition, commercial marketing, or the world of digital interaction to drive users to do the heavy lifting of product adoption. Instead, he is relying on old-fashioned, even banal, forms of financial education.

Sam is finally enrolled. The process involved a painful set of choices and a pinch to his pocketbook. He is not sure he likes his product but says, “I could not have enrolled without lots of people telling me about it and watching video clips – both funny and serious. I finally got the point.” Sam is a college graduate. English is his first language. For Sam, financial education was crucial.

*Cross-Posted with Accion’s Center for Financial Inclusion