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Insurance companies aren't as confident as the White House is that Healthcare.gov will be up and running at the end of the month, and they're pushing the Obama administration to let them enroll people eligible for subsidies directly through their websites, The New York Times reports. No one's saying the website is doomed, but maybe, possibly, it might be a good idea to have a back-up plan, given what happened the last time everyone was sure the federal exchange site would work.

The Obama administration said no, justifiably concerned about giving insurers access to people's private tax information. Officials within the White House said they've always considered alternative methods to enroll people, but it's "of additional value now" for obvious reasons. So while the White House shot down the insurer enrollment short cut, a recent statement from their health care adviser Chris Jennings said the administration was "continuing to pursue additional avenues by which people can enroll, such as direct enrollment through insurance companies, that will help meet pent-up demand." Some other ideas:

  • Allow insurers to work directly with shoppers to estimate their subsidy, and hope it matches with the federally verified subsidy down the road.
  • Let people enroll before their paperwork is completed.
  • Extend the enrollment period for months, deeply upsetting the insurance industry.

All of those options are complicated and unlikely for various reasons. Letting people enroll before they complete their paperwork isn't a sustainable solution, and insurers absolutely do no want the enrollment period extended, nor do they want to run the risk overestimating subsidies. But if the site isn't working at the end of the month there are a few worst case scenarios to consider. Some sick people on Pre-existing Condition Insurance Plans are set to lose their insurance at the end of the year. They need to sign up for insurance by December 15, regardless of whether the site is working. And, as Megan McArdle prophesied in a Bloomberg View op-ed yesterday:

The exchanges aren’t ready by Dec. 1. In fact, they continue to experience problems in January and February. The administration’s poll numbers continue to plummet, and the reputation of the exchanges is such that come spring, young people don’t bother to sign up -- or are afraid to hand over their personal data to such a buggy system. The insurance pool is much smaller, older and sicker than expected, which is to say, much more expensive than expected. The administration comes up with small emergency patches, like allowing people to keep their old policies for a few more months. But that makes the pool of people insured through the exchanges even older and sicker than it otherwise would be.

The success of the federal exchange on November 30 will play a role in the first year success of the law and the administration's approval rating. As if the White House needs any more motivation.

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