KI: Well, it strained resources at the plan level. I mean, their human and financial resources. Because there are two sides to the operating environment, right? What consumers see, which is the front end, the front door of the website. And then the back end, which consumers don't see as much. But to work intensively through the challenges, to take a website that was going to largely work in an electronic fashion, and to actually be required to do quite a number of the functions by hand, essentially -- that's a very different state of affairs than what was expected, what was predicted, etc.
So the challenge has been on the ground for the plans to actually work on just the number of the back-end issues in a way that they never expected. And to their credit, we have a number of technology experts, operations experts, that are working very, very hard to provide input to CMS and advice about what they're seeing, whether the testing is working, whether certain strategies are working, etc. And that's been a very important part of the process, certainly for the agency.
NJ: When you mentioned earlier that you think we're going to see more discussion in the policy community around transitional [policies], what do you mean by that?
KI: I think the question is, what do people want to buy, and what options should they have? And do we have enough options for them at present? And one of the things that became very clear in the fall is a concern on the part of people who did have coverage -- they didn't want to lose it. And in part they were concerned about moving from coverage they had, which had not necessarily included all 10 categories of coverage, and buying up. So now the question, from a policy perspective, is how do you address those challenges? Are there additional options that are offered to individuals? What can we do to make people feel more comfortable in having a broader set of options? And I think that will be a subject that's discussed quite a lot in the policy community, as it should be, because I think people just generally like to have a more gradual adjustment.
NJ: Would you take away some essential health benefits, or expand age rating? What would you do?
KI: I think it's not a question of taking away benefits, but it's a question of whether or not there could be alternatives that would allow people to -- whether its to purchase coverage that is, from an actuarial perspective, is a little less than the actuarial value of a bronze plan. Things of that sort.
NJ: To that point, most of the people who have signed up so far have been picking silver plans. They haven't been choosing the bronze "¦ Why do you think more people haven't chosen the less expensive plans?
KI: It's the old adage, where you stand depends on where you sit. So if individuals have high health care costs and have incomes that ensure they are getting subsidies, then I think they'll make a decision to purchase a more generous plan. For people who are not necessarily eligible for subsidies, or eligible only for small subsidies, then they become very economically sensitive. They're looking at price very specifically. And I think those individuals are more likely to buy something a little less than silver.