Some health insurance exchange work is behind schedule

Government entities have made inroads toward establishing federally facilitated health insurance exchanges and marketplaces for small businesses, but additional work lies ahead to get these systems operational by Oct. 1, the Government Accountability Office concluded in two recent reports.

The Centers for Medicare and Medicaid Services has had success in completing certain activities to establish the federally operated exchanges, but many tasks still are unfinished or behind schedule, the GAO stated in one report (link). Federally facilitated exchanges will be run by CMS and are scheduled to operate in 34 states; other states have chosen to operate their own exchanges or partner with the federal government to run the insurance marketplaces.

“The activities remaining cross the core exchange functional areas of eligibility and enrollment, plan management and consumer assistance,” the report stated. The GAO made similar conclusions in a report that focused on Small Business Health Options Programs, or SHOPs, citing development and funding delays that were taking place in one program to provide enrollment assistance and outreach to small employers and their workers (link).

The Dept. of Health and Human Services said it was confident that the new insurance marketplaces would be operational in all states by Oct. 1, when open enrollment begins for consumers. GAO noted that CMS had been working on a data hub to supply consumer eligibility information to state agencies and the exchanges, and was helping states to develop contingency plans for their exchanges.

“Whether these efforts will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” the watchdog organization stated.

House and Senate Republicans who requested the report said the findings underscored the Obama administration’s lack of readiness in implementing the Affordable Care Act. “What the GAO found is what most Americans have known all along: This law isn’t ready for prime time, and come October millions of Americans and small businesses are going to be the ones suffering the consequences,” said Sen. Orrin Hatch (R, Utah), the top Republican on the Senate Finance Committee.

On June 24, HHS announced new consumer educational tools such as a 24-hour call center to help individuals prepare to enroll in exchange plans.