[daguar]

The key question here is how much additional value-add does SimplyInsured provide over the online marketplaces being set up under the Affordable Care Act.

A significant part of the broker's value is the high-touch relationship and trust.

The market fit question to me is: if a state marketplace has a decent web portal (like California's http://www.coveredca.com ), what additional value does a private portal offer that NEITHER the official portal NOR an offline broker can offer?

(Don't mean this as polemical by any means; lots of states are not going to have great portals. Just interested in hearing opinions on this.)

[Edit: making CA link a real URL]

[nhashem]

I'd argue the ACA will enhance the market for SimplyInsured. Yes, for an individual who wants a basic policy, Covered CA will probably be sufficient and they won't need more help than that. But there are dozens if not hundreds of edge cases.

Some examples off the top of my head:

- A healthy 24 year old software engineer is making $75,000. This means he doesn't qualify for any of the tax subsidies by buying insurance on the exchange. He wants to avoid the $2,500 penalty for being uninsured, but every plan on the Covered CA will cost more than that over 12 months. Perhaps his best option is to buy an individual policy for catastrophic coverage only.

- A small business isn't sure whether it's optimal to insure their employees, or just give them a cash "bonus" and tell them to buy their own policy on Covered CA (similar to what Trader Joe's announced they're going to do with their part-time employees).

- Purchasing insurance on Covered CA is limited only to certain enrollment periods (this is perhaps the biggest misunderstanding, as I've seen various media personalities ask "why wouldn't healthy people just wait until their sick, and then get insurance?" countless times). However, there are exceptions for a life-changing event. Thus, a person who is laid off (thus counting as one of those life-changing events) would like information on whether their best option is to pay for COBRA or buy a policy on Covered CA.

Basically the ACA is complex, but it does turn health insurance into a much more structured and transparent market, which lends itself well to applications like SimplyInsured. Otherwise, what could any sort of system do for my third scenario, for example? All anyone could advise to have them stay on COBRA because they'd probably get screwed by letting it lapse and then trying to get an individual policy.

[mjn]

I agree on the last point: ACA probably actually helps them by making this kind of analysis possible to automate, since it gets the plan data into some kind of commensurable, analyzable form, and simplifies the answers to all kinds of eligibility questions. Once you have a standard format for health-insurance offerings, one analogy could be with air travel, where people build sites like Kayak and Hipmunk on top of ITA's systems. That isn't possible to do adequately if every health plan has its own custom set of terms written in English/legalese.

[vivekajayshah]

Exactly! Unfortunately - the ACA "format" is still legalese... like this (government mandated form) http://www.seechangehealth.com/SitePages/PDFLoader.aspx?Titl...

We've built software to normalize despite that - check us out!

[vivekajayshah]

Check out our blog post here: http://blog.simplyinsured.com/what-startups-need-to-know-abo...

The chart under Question #2 - answers your question.

[briandear]

I'm pretty confident that SimplyInsured's IT would be a huge improvement over the continual problems with the technology of the exchanges. The private sector is far better equipped to actually deliver on the technological promises made by the exchanges. The government is always years behind technologically due to the procurment process. The only reason the NSA has the advantages they do is because much of the technology they use is classified and this not open to potential competition.

There's a role in the government for insurance regulation, however companies like SimplyInsured are needed to actually execute.

This is FedEx vs. the Post Office.

[fpgeek]

I completely agree that the key question for SimplyInsured is how much value they can add once the decent exchanges are up and running. That's why I'm surprised that they've been focusing on California rather than Massachusetts.

Yes, California is a much larger market, but the Massachusetts exchange has been up and running for years. Given that, it seems obvious to me that, for now, Massachusetts is a far better proving ground than any other state for a health insurance business.

[tednaleid]

I think that there's definitely room for improvement in this space as well as a lot of money to be made because the public exchanges so far are kind of terrible in their usability and access. They will probably improve, but with the lock-in they currently have, there is only incentive to improve enough that the complaints slow down. They get no additional profit for actually making things any better than "possible".

Some previous colleagues of mine just raised 2.6M a couple of weeks ago [1] for a very similar sounding idea [2]. This is a hot space right now with all of the attention on health care because of the ACA and all of the failings of the public exchanges in the press.

[1] http://www.bizjournals.com/twincities/blog/in_private/2013/0... [2] http://www.gravie.com/

[downandout]

They may find themselves with a bigger market than one would think. Correct or not, the general perception of the exchange-based plans is that they are nothing more than extremely limited HMO's (having looked at the plans, this actually seems to be the reality, at least in Nevada). That negative perception, combined with the fines for not having insurance, along with the end of underwriting, will probably lead to a significant spike in people looking to buy private health insurance away from the exchanges. Another large group of people that will refuse to participate in the exchanges will be those that are ideologically opposed to the idea of Obamacare, and those that have grown distrustful of the government's use of data in the wake of the NSA scandal.

[Scotthm]

The portals will be decent for individuals who enroll, but for small companies, they are a joke.