As the federal government and states continue to refine their exchange websites, they may want to take fuller advantage of insights from behavioral sciences regarding the influence of design architecture on people’s choices. For starters, we believe that the websites should downplay powerful connotative labels such as bronze, silver, and gold. In addition, they should deemphasize complicated tables of financial information that lay out cognitively overwhelming details about premiums, copayments, deductibles, out-of-pocket maximums, and the like. Instead, they should make it easier for shoppers to estimate total annual costs under a series of plausible scenarios, such as expected utilization based on previous spending history, as well as under best-case and worst-case scenarios. Finally, when the influence of design architecture on choices is unknown, designers should partner with researchers who can run experiments to inform the process.
Health insurance exchanges have the potential to revolutionize U.S. health care markets. To maximize this potential, we think it’s incumbent on states and the federal government to minimize the potential for the public face of these exchanges to bias people’s choices. Supreme Court Justice Louis Brandeis once observed that a “State may . . . serve as a laboratory; and try novel social and economic experiments.”5 The current health exchanges represent one very complicated experiment; we hope that state and federal decision makers are observing the outcomes.