Healthcare for Geeks: A Discussion from BarCamp Philly

On Saturday, I attended a fantastic annual event known as BarCamp Philly.  If you’re not familiar, it’s an “unconference” – a conference with a user-generated schedule packed with a wide variety of user-generated content. BarCamp tends to be more techy/web-oriented, but the topics extend to all areas of life, from transportation to food to raising geeky kids.  If you weren’t there this year, I’d keep an eye out for info on next year’s.  The unconference is a pretty brilliant format.  Setting the schedule the morning of the event breeds excitement and community and even brand-new ideas for talks.  (If you’re thinking we could use that kind of energy in public health, I’m with you.  More on that in a future post.)

After a midweek shower epiphany, I decided to use a small part of my BarCamp time to host a discussion on the Affordable Care Act’s impact on the tech community.  My session was sleepily and unsexily titled “Healthcare for Geeks,” and would focus on  insurance for freelancers, start-ups, and entrepreneurs.  I came with a small stack of paper handouts (quaint, I know), but mostly I came with questions.

We started the session off with a review of some figures.  We talked briefly about the subsidies and cost-sharing that are available to people without employer-provided coverage making between 100% and 400% of the federal poverty level ($11,490 – $45,960 for individuals, $23,550 – $94,200 for a family of four).  We also talked about the premiums on the health insurance marketplace (which range from $147-$357/month for a 27 year old in southeastern PA).  At the time, I had an Excel spreadsheet with the rates; since Saturday afternoon, I’ve learned about a fantastic marketplace premium aggregator site that covers 34 states.  (Note: the aggregator site recommends contacting the insurance companies directly to sign up for a plan, but subsidies are only available when signing up through the Marketplace.)   Given that information, our group was able to get into the meat of the discussion.

Americans have long been accustomed to the idea that a good job is worth having for the health insurance alone.  I personally know dozens of people that have successful part-time businesses, but have never been able to quit their day jobs because they needed insurance.  At the same time, widely-available insurance doesn’t mean free healthcare.  My main question for Philly’s tech community was this:  In a field that skews toward relatively young, healthy, well-resourced men – a demographic that doesn’t tend to access preventative care, and might have been more comfortable living without insurance than other groups – will the Affordable Care Act help or stifle innovation?  And will the new healthcare options reduce barriers to entry to the field for women, parents, people with pre-existing conditions, and other groups that would have been more averse to walking away from insurance?

I wish I could say that we came up with all the answers in that Wharton classroom.  We didn’t.  But our twenty-five(ish) participants seemed hopeful… in the long run.  People are excited about the idea of freelancing full-time or starting new businesses while still having access to health insurance.  But in the here and now?  Almost everyone is confused at best, and many people are scared.

Frankly, I was disappointed.  Not in the conversation (honestly I was excited that anyone showed up and thrilled that they wanted to talk), but by the lack of information.  Here were a group of smart people who are incredibly good at The Internet, and even they hadn’t been able to find the information they needed about their health insurance options.  (An aside: props to us all for not lapsing into a 45-minute healthcare.gov vent session.)  If these very capable people don’t know that health insurance companies have to spend 80% of premiums on actual healthcare, then who does?  And how will we ever get this information out to anyone but health policy wonks?

This adventure in bringing public health discussions to BarCamp Philly is something that the CDC might call “non-traditional methods of stakeholder engagement.”  But to steal another CDC term, it’s hardly a scalable approach (meaning that it’s not the type of thing that can be done on a big enough scale to reach a good number of people).  We will never have enough public health workers willing to spend their days off having conversations about the ACA with seemingly random groups of people, at least not enough to make a large-scale difference.  Yet we know from our discussion that the new availability of insurance could create some serious opportunity for creativity and innovation – something that we could surely use.

So, I’m going to turn to you, creative and intelligent reader.  Clearly what we’re doing isn’t working.  (See: our very first post on Badass Public Health.)  What tools do we need to reach people that don’t talk about health policy for fun?  How do we separate fact from fiction?  Where do we go from here?  And where do we start?

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