civic tech, UX

The Terrible, Horrible, No Good, Very Bad, Money-Grubbing Dark UX Patterns of Healthcare.gov


Note: in design-speak, a “dark pattern” means that a bad website experience is not the result of mere ignorance or incompetence, but rather, is the result of a malevolent and deliberate design choice that hurts the person using the website by tricking them into doing things they don’t want to do.

You know, I didn’t want to write this. I support the ACA, I really do. But I don’t support deceptive software design, which healthcare.gov is unfortunately practicing.

Let’s leave aside for the moment the baffling site navigation and terrible instructions, which I’ll get back to later, and focus on the billing, because that’s what made me angry enough to put aside my reservations and write this.

Because I was between jobs in 2016, I signed up for an ACA plan for a few months. I was lucky enough to get a job with insurance, so I went to cancel my plan, which is when I found out about the first round of objectionable design choices. For instance, you can’t cancel your plan right away. Your cancellation date is set, automatically, as 14 days from the day you’re doing it, and you cannot change the default.

Well, that’s shitty. Really shitty. I see no possible benefit for you, the user, though I do that it’s a terrific boon for the insurers who are taking your money. Add to that the hard-to-find and sometimes incorrect instructions — or more precisely lack thereof — on how to actually terminate your coverage. I found the instructions, though, and it seemed to work ( the site never confirms any action you’ve taken, another terrible design choice) and I finally got a letter from my insurer in December 2016 saying it was cancelled and “no further action was required.” I also ignored the many pleading calls, both robo and human, begging me to “complete my 2017 healthcare.gov application”, because I assumed I’d terminated it.

Hahahaha.

Fast forward to late January, when I finally open the insurer envelope that I assumed were 2016 tax information.

Hahahaha, again.

Turns out I had been signed up for 2017! Without my knowledge! So of course I head over to healthcare.gov — I know from my previous exchange that the insurer won’t do squat until the marketplace tells them to — and lo and behold, there’s 2017 coverage, which is active.

Did I mention that the insurer now wants $725 for coverage I hadn’t signed up for and wasn’t using?

Yeah.

So of course I call the marketplace helpline and am told that when I initially signed up I agreed to yearly autorenewal. Interesting, and the the first I’ve heard of this. The representative says there was a checkbox. Maybe there was, and maybe there wasn’t, but there’s definitely not one now, and there won’t be one. As in, I cannot change this particular setting, ever.

So, here’s the thing:

Secret automatic autorenewal is a vile way to wring money from people. Especially when your messaging doesn’t get across that’s it’s happening, and especially especially when there is NO WAY TO REMOVE YOURSELF from the process. Most especially when you’re told, as I was, that you will now have make a phone call, every year for 5 years, to tell the healthcare.gov to tell the insurer that they may not take your money.

And let’s talk for a moment about defaults. The power of defaults to nudge behavior is well-known. But this carefully hidden default isn’t a nudge. This is straight-up misinformation from a website that makes some fairly important decisions for you, without telling you.

And you know what makes me most filled with rage? Healthcare.gov isn’t even the one who bills you. They have “nothing to do with billing”, and boy, do they like to remind you of that, once you’re yelling at them. (I wasn’t actually yelling; for the record, I know it’s wrong to yell at customer service reps with no power.) So I’m told that I can take it up with the insurer, who I’m sure will be very happy to just drop the charges, oh, except  they won’t, because they’ve already received “official” notification of my renewal, and then they’ll receive an “official” stop date of 14 days from today from healthcare.gov (who, remember, has “nothing to do” with billing) so it’s out of the insurer’s hands too. Alas.

In short, the insurer gets to tell you that their hands are tied until healthcare.gov cancels the policy, and then healthcare.gov gets to tell you that their hands are tied because don’t have anything to do with billing. And the reps can’t do anything more than you can, by the way, so even if you call they’re requiring you to pay the insurer for those 14 days of coverage, after the website has already done the dirty work of opting you into a neverending, autorenewing policy. As the church lady would say, that’s convenient. At this point, I’m guessing that required insurance wasn’t the only thing promised to insurance companies; I’m thinking an official government signup process that forces random, already-insured people to pay a couple months of needless premiums every year — unless they call, of course — is a nice additional perk.

At its heart, this is design that harms buyers, which I’d totally expect it from money-grubbing companies. But technically, this is a government site. The government is supposed to do better, and has been doing better — so much better! — with things like 18F.

And one of the reasons I didn’t complain, the first time I got angry, was because I thought okay, this is a first-world problem I have, and I’m equipped to deal with, to pay for an extra half-month of coverage I don’t need. And okay, maybe the default users are assumed to be return enrollers — though I’d like to know if that’s true, and if so, if there’s any research supporting that assumption.

But now I’m asked to pay for two whole months (after the rates got jacked up, natch) of coverage that I didn’t need, purchase, or ask for in any capacity, and while I’m sure I can deal with random $725 charges better than a whole lot of people — and believe me, I’m grateful for that — I’m not yet rich enough to “afford” it, in a meaningful way. There’s no appeal, because it’s not technically a “decision” they’ve made, for example, about your eligibility. Except it totally is, in that they’ve decided you’re all-in, whether you know it or not. The reps, predictably, “can’t do anything” beyond what the site does. That I believe, but where are the people in charge of the site itself? Anywhere to be found? Can I contact them? Nope, of course I can’t.

Also, this stuff is not hard to fix. Just put a goddamn renewal checkbox in there, and let me uncheck it. Let me remove my account altogether. Send me a notice that says “HEY WE’RE AUTORENEWING THIS SHIT RIGHT NOW”, with AUTORENEW in big red letters, instead of making a billion phone calls implying they won’t renew it unless I do something.

Oh, and finally: let me give feedback. Because there’s nowhere on the site to do that, now. None. You can give feedback on the information pages, but there’s no customer service email that will let you follow the thread of your conversation with someone. That’s also pretty shitty, come to think of it.  So my only option, other than writing this, is to take to social media and shame healthcare.gov or the insurer, and see who breaks on the “hands are tied” first. Now, I don’t want to do that, but I will, for $725.

I still feel a little bad writing this, but not as bad as I did before I started writing. Because the fact is, the site is doing what a lot of sites do, which is to deliberately trick people into spending more money than they intended to. That explains the senseless information architecture, the lack of communication, the generally terrible design. Because probably it was designed to do one thing, which is “get people signed up” (code for getting people to shut up and give their money to the insurers). Never mind treating the site as a mature piece of software that needs to deal with people who are already signed up, or who want to leave, or who have any issues other than being hapless consumers.

And apparently I’m not the only one who thinks so: see here and here and here. It’s fallen out of vogue to complain, because it’s years after the launch and there are so many other things to worry about, but I’ve never been one to follow trends. And I’ve found a lot of other people complaining about this in consumer forums.

Healthcare.gov, you’re better than this. Or at least I hope you are.