One of the big promises of the Affordable Care Act has been to bring greater transparency to the country’s convoluted health care system.

Everybody, the Obama administration has argued, should be able to go online and easily compare health insurance plans based on their costs, their services, and the providers included in their network.

A new study that examines a number of state-run ACA marketplaces finds that attempts to provide the type of apples-to-apples comparison envisioned in the landmark health law are still falling far short.

The study by the Princeton, New Jersey-based Robert Wood Johnson Foundation examined state-run marketplaces in Massachusetts, Connecticut, New York and Oregon.

One of the major obstacles to price clarity has been the persistence of “nonstandardized” plans in most marketplaces. However, starting next year, all four states will require insurers participating in their marketplaces to offer a “standard” plan at each level — gold, silver and bronze. Such plans have a preset cost-sharing amount.

But the existence of “standardized” plans does not mean that non-standard plans are going away. Consumers in all four state marketplaces may continue to unwittingly pick plans with a cost-sharing scheme that is significantly different than the “standardized” options.

On none of the four marketplace websites can consumers specifically search for standard plans and none of the websites appear to highlight such plans with an icon or something else that might be easy to identity.

The good news, notes the study, is that the federal government has indicated that it will put in place such visual cues when it rolls out its own set of standardized plans on healthcare.gov next year.

In addition to making a clearer distinction between standard and nonstandard plans, the study authors suggest that marketplaces may want to simply limit the number of plans insurers can offer. Of course, insurers argue that it is important to allow them to experiment with different cost-sharing designs that some consumers might appreciate.

"Regarding standardized plans, the tradeoff between increasing simplicity versus potentially impeding innovation is not obvious," Kathy Hempstead of the Robert Wood Johnson Foundation said in a statement. "In some ways it boils down to whether you think the bigger problem is that of too much or too little choice. Clearly, some states that embraced standardization have had trouble delivering benefits to consumers."

Instant Insights /

ACA marketplaces still need work on price transparency

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