As technical problems with the government's new health insurance marketplace slow the pace of sign-up, a variety of "fixes" have been proposed. But some of these would create their own challenges. In rough order from least to most disruptive, here are some of the ideas:
1) Fix the website on schedule
This is everyone's favorite idea. The Obama administration says it hopes to have HealthCare.gov working smoothly for most users by the end of November, though it's not clear that target will be met.
2) Use alternative government sign-up paths
A 1-800 number and enrollment by mail can save would-be customers hours in front of a frozen computer screen. But ultimately, all the enrollments have to be processed through the same computer system.
3) Direct sign-up with insurance companies
Customers can use HealthCare.gov or commercial websites to shop for coverage without a lengthy enrollment process, then contact insurers directly to sign up for coverage. For now at least, though, people who use this option will not be able to take advantage of government subsidies.
4) Extend enrollment window / delay individual mandate
If timely enrollment is not possible, there will be pressure to extend various deadlines, beyond mid-December for coverage that begins in January and beyond late March to avoid a penalty. Without the pressure of these deadlines, though, younger, healthier people may wait longer to sign up, leaving a sicker, costlier pool of patients covered and potentially driving up premiums.
5) Preserve nongrandfathered, nonconforming private plans
Lawmakers are considering options to codify the president's promise that people who like their old health insurance can keep it, even if those plans don't meet the minimum standards set by the Affordable Care Act and aren't already grandfathered in. Experts cite several potential problems with that: Those policies don't include the consumer protections of the health care law, and by siphoning off healthy customers (who were generally the only ones who qualified for coverage under the old system), this would also skew the pool covered on the exchanges, raising prices for everyone else.
6) Something else?
The White House has promised its own plan to help those whose policies have been canceled and who have not yet been able to sign up for new coverage. There's no word yet on what that plan might include, but spokesman Jay Carney says it will be announced sooner rather than later.
STEVE INSKEEP, HOST:
We now have a better sense of just how slowly enrollment has started for new insurance plans through a federal website. The Obama administration says just 27,000 people managed to sign up for insurance coverage on the troubled federal site in its first month. Another 79,000 got coverage through state websites.
RENEE MONTAGNE, HOST:
Those numbers are a fraction of what the government hoped to see. Authorities have been encouraging citizens to try other options, or just try the website again. But many options have their own problems, as NPR's Scott Horsley reports.
SCOTT HORSLEY, BYLINE: The Obama administration has said all along it expected enrollment in the new health insurance marketplace would start slowly. But even with those low expectations, October's numbers were a disappointment. Only about one-fifth as many people bought coverage as the government initially forecast.
ROBERT ZIRKELBACH: While these initial numbers are an important first look, it's by no means the end of the story.
HORSLEY: Robert Zirkelbach is a spokesman for America's Health Insurance Plans, an industry trade group. He says the government website, with all of its problems, is artificially depressing sign-ups.
ZIRKELBACH: There's no question that the technical challenges with HealthCare.gov have made it very hard for many people to sign up. What I can say that health plans all across the country have seen a very high level of interest among consumers wanting to sign up for coverage.
HORSLEY: Indeed, traffic on both the state and federal websites suggest considerable pent-up demand for health insurance, even if much of that traffic ended up jammed. Nearly 27 million different people logged onto the sites in October - only to find, in many cases, an Internet dead-end. As the depths of the problem became known, President Obama tried to steer some would-be customers onto alternate routes.
(SOUNDBITE OF PREPARED REMARKS)
PRESIDENT BARACK OBAMA: They can still apply for coverage by phone, by mail, in person. There was a time when the Internet didn't exist.
OBAMA: It wasn't that long ago.
HORSLEY: Those alternative sign-up strategies have spared some customers from hours staring at a frozen computer screen. But Sabrina Corlette, of the Center on Health Insurance Reform at Georgetown, says even those old-fashioned applications eventually have to be processed through the same, balky computer system.
SABRINA CORLETTE: While it often helps to be able to talk to a real person, or be able to drop a form in a mailbox - you actually feel like you completed something - at the end of the day, everybody's got to get through that funnel.
HORSLEY: Health Secretary Kathleen Sebelius says some customers can bypass that chokepoint by taking advantage of the website's shopping feature without the trouble of actually signing up.
SECRETARY KATHLEEN SEBELIUS: They could go to HealthCare.gov - to the learn side, pull up the by-state option; shop for a plan and actually, directly contact the insurance carrier they're interested in.
HORSLEY: There are also commercial websites that allow customers to shop for coverage, then buy directly from insurance companies. For now, though, only customers who purchase through the federal or state-run websites can qualify for the government's insurance subsidies. As the administration tries to repair the website, members of Congress are looking for ways to help those whose old policies are being canceled. Republican House Speaker John Boehner likes a bill that would let insurance companies keep offering any policy they sell now, even if it doesn't meet the new coverage standards of the health care law.
(SOUNDBITE OF SPEECH)
REP. JOHN BOEHNER: This is not about politics. These are about real people in our districts that are being harmed by Obamacare. It's time to fix this law.
HORSLEY: But Zirkelbach, who's with the industry trade group, warns any proposal to extend old insurance policies, or postpone the deadline to sign up for new ones, could upset Obamacare's delicate economics.
ZIRKELBACH: If the rules are to change at this stage in the game, that could change who ultimately participates in the marketplace and ultimately, could result in higher premiums for consumers.
HORSLEY: That's why policy experts - like Georgetown's Corlette - say the best way to fix Obamacare is to get the website running properly, and fast.
CORLETTE: That would be the No. 1 fix on my plate: Make sure that people can get online. And I think many, many, many millions of people will find that they can get good value on these exchanges, if they could just see what's available.
HORSLEY: Yesterday, Secretary Sebelius repeated the administration's forecast that the website will be working smoothly for the vast majority of users, by the end of this month - a timeline many observers consider ambitious.
Scott Horsley, NPR News, Washington. Transcript provided by NPR, Copyright NPR.