Google Search Gaming May Be Luring Users Into Skimpy Health Plans

Philly.com

It started with a click.

Determined to cross “buy health insurance” off her list, Robin Allen sat down at her computer last fall and Googled the federal government website where consumers can enroll in plans that meet coverage requirements of the Affordable Care Act. She typed in some basic health information, her phone number, and within minutes her phone was ringing.

Allen was impressed that an agent was available to help her at 9:30 p.m. She went to bed enrolled in a plan with no deductible, low-cost vision and dental coverage, and all the doctors she’d need -- all for a $300 monthly premium.

“I didn’t have any reason to believe that was not the way it should be done,” said Allen, 55, of Erdenheim, Pa., who had been covered by her husband’s employer plan until they divorced.

But she wasn’t on the government’s website, healthcare.gov. The broker she spoke to doesn’t sell major medical insurance and the plan she bought was far from the full coverage she thought she was getting.

Insurance-quote websites designed to resemble the government-run marketplaces spend millions of dollars for top billing on Google when people search keywords like “Obamacare plans,” “ACA insurance,” and even “healthcare.gov.” Rather than selling insurance directly, they hand off consumers to agents, many of whom are misleading consumers into buying products that offer little coverage.

These websites have been around for years, but have become a bigger consumer concern since the Trump administration loosened regulations on short-term, limited-duration health plans. Today, it’s possible for plans never intended to serve as primary health insurance to be sold as year-round coverage.

What’s more, the administration has slashed the ACA’s public outreach budget, leaving healthcare.gov no way to counter with ads of its own.

Many Republicans argue limited-benefit plans should be available for people who do not want all the coverage the ACA requires of major medical insurance.

Some consumers may not want some ACA mandates, such as maternity and mental health coverage. But limited-benefit plans often leave out a lot more -- like coverage for preexisting conditions -- since they are not legally required to follow ACA rules. Yet the companies and brokers selling these plans often do not make that clear.

“There are websites that are designed to confuse people -- or at least they seem designed to confuse,” said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms.

The problem is exacerbated by the fact that search engine ads often do not look much different from real search results.

The issue of ad clarity has long been on the radar of the Federal Trade Commission, which regulates search engines.

House Democrats last week pushed through a package of health care bills that would reverse Trump’s expansion of short-term health plans and restore funding for groups that help people enroll in healthcare.gov. Senate Democrats this week introduced a companion bill to address short-term plans.

But with a split Congress, the task of protecting consumers has fallen to the states, which have varying restrictions on limited-benefit plans and little ability to wrangle websites that operate seamlessly across state lines through the Internet.

In the meantime, consumers are left in a difficult-to-navigate insurance market, where one wrong click can land them in an insurance plan with thin benefits and significant exposure to high medical costs.

Millions spent on ads

Google “healthcare.gov” and the first three to five results that show up above the federal government’s marketplace website are ads, mostly for insurance quote websites with official-sounding names.

Websites bid for their ad to show up when people search for certain keywords.

Between 2014 and 2017, more than 2,800 advertisers spent $46.6 million sponsoring about two dozen ACA-related search keywords, according to analysis by Kantar, a data and market research company.

Six websites outspent the federal government, which put $1.4 million into Google ads for healthcare.gov in 2017, according to Kantar.

All Web Leads, an Austin, Tx.-based lead-generation company, was the second-biggest spender that year, shelling out $3.2 million to attach its website, affordable-health-insurance-plans.org, to heavily searched ACA keywords.

A majority of the people who visit the website, which predates the ACA, can’t afford marketplace plans and are looking for a cheaper alternative, said Bill Daniel, CEO of All Web Leads.

Yet the hyperlinked text in its Google ad says “HealthCare.gov 2019.” The homepage advertises “Obamacare Plans from $9/wk” and notes that all of the plans agents sell meet federal standards under the ACA. That’s true, but not very meaningful, since short-term plans are exempt from the law’s coverage requirements for major medical insurance.

The site’s ACA branding attracts shoppers during the government marketplaces’ fall open enrollment. That’s when many of All Web Leads’ customers -- brokers and insurers -- sell plans that meet ACA standards for full health insurance, Daniel said.

He doesn’t think many people have trouble distinguishing full coverage from skimpy coverage.

“I don’t think that’s a significant problem, based on what we hear from consumers. They do contact us if they’re not happy with the connection we’ve made for them,” Daniel said.

Designed to confuse

Insurance quote websites note on their homepages -- usually in tiny type -- they’re not affiliated with the government, but even people with decades of health policy experience can’t always tell the difference.

Every year Ezekiel Emanuel, chair of the University of Pennsylvania’s department of medical ethics and health policy, assigns his students to shop for health insurance using the government marketplaces. One year he did the exercise, too.

“It took me about 15 minutes to realize I wasn’t at healthcare.gov or a state exchange,” Emanuel said. “Unless you know what the right place looks like, what the offers are, they’ve done a very good job of making it look like it’s the [government] health insurance site.”

While Emanuel’s error was merely a class exercise, consumers who make the same mistake often discover the plan’s shortcomings only when they have a medical issue.

Allen realized her mistake when she checked her plan’s coverage for a specialist visit she wanted to schedule.

She learned that she had not bought conventional health insurance. Instead, she had an indemnity health plan, which pays a set rate for a select list of services. They are designed as add-ons to primary health insurance. United States Fire Insurance Company, the plan’s underwriter, did not respond to a request for comment.

In her case, the plan would pay nothing for that specialist visit.

According to Pennsylvania’s directory of licensed insurance brokers, the agent who sold her the plan has agent privileges with three insurance companies, including USFIC -- none of which sell major medical health plans.

“I was like, oh my God, I have been completely scammed,” Allen said.

With help from a local professional, Allen has since enrolled in a full insurance plan. But she recalls how overwhelmed she felt at her initial discovery.

“I just put my head down on my computer and started to cry. I didn’t know what to do,” she said.

She hasn’t been able to get her money back, yet.

Discreet ad labels

Back in the early 2000s, Google ads appeared in hard-to-miss colored boxes. Now they’re marked by a tiny quarter-inch white label with a green outline.

A 2017 FTC report recommended that search engines use bigger, brighter ad labels at the very top of a listing, and easily understood phrases like “paid content.”

“For a company with the gargantuan size and influence of Google they should have some moral responsibility that they are not misdirecting users,” said Megan Gray, general counsel for Paoli-based search engine DuckDuckGo.

DuckDuckGo uses a white ad label similar to Google’s, but lists just one ad above organic search results and includes a button where consumers can report bad ads.

Yahoo lists about five ads separated from search results by a thin horizontal line.

Bing’s ad label is hard to catch -- it’s smaller than Google’s and outlined in light grey.

Google has on a few occasions banned ads criticized for targeting vulnerable individuals, such as ads for alcohol and drug rehab and payday lending.

But vetting millions of ads would be difficult because knowing whether an ad is misleading requires understanding the industry, said Gray, who previously worked for the FTC as a consumer protection attorney.

Google did not respond to a request for comment.

Others say the only way to truly protect consumers is to rein in the plans themselves.

“While I absolutely think it is wrong for companies selling these junk policies to take advantage of unsuspecting consumers, we should not have to rely upon platforms, like Google, to take on the role of a regulator,” Sen. Bob Casey, a Pennsylvania Democrat, said in a statement.

The Senate’s bill to reverse Trump’s policy on short-term plans builds on the House’s legislation, which also restores $100 million in funding for “navigator” groups that help individuals sign up for marketplace plans.

House Democrats had attempted to force Republican support for the measure by tying their bill to a bipartisan drug pricing bill, but all but a handful of Republicans voted against the measure.

While lawmakers debate the rules, consumers are left to dodge through a digital minefield.

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