After months of speculation on just where the Obama administration is toward the development of the new health insurance exchanges, the Government Accountability Office (GAO) has issued a 48-page report complete with timelines and a detailed report on just where the Obama administration is––or at least was last month.
The key summary:
“Much progress has been made, but much remains to be accomplished within a relatively short amount of time. CMS’s timelines provide a roadmap to completion; however, factors such as the still-evolving scope of CMS’s required activities in each state and the many activities yet to be performed—some close to the start of enrollment—suggest a potential for challenges going forward. And while the missed interim deadlines may not affect implementation, additional missed deadlines closer to the start of enrollment could do so. CMS recently completed risk assessments and plans for mitigating risks associated with the data hub, and is also working on strategies to address state preparedness contingencies. Whether these efforts will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined. ”
Regarding the Data Hub:
“FFEs [the federal exchanges] along with the data services hub services are central to the goal under PPACA of having health insurance exchanges operating in each state by 2014, and of providing a single point of access to the health insurance market for individuals. Their development has been a complex undertaking, involving the coordinated actions of multiple federal, state, and private stakeholders, and the creation of an information system to support connectivity and near real-time data sharing between health insurance exchanges and multiple federal and state agencies. Much progress has been made in establishing the regulatory framework and guidance required for this undertaking, and CMS is currently taking steps to implement key activities of the FFEs, and developing, testing, and implementing the data hub. Nevertheless, much remains to be accomplished within a relatively short amount of time. CMS’s timelines and targeted completion dates provide a roadmap to completion of the required activities by the start of enrollment on October 1, 2013.
However, certain factors, such as the still-unknown and evolving scope of the exchange activities CMS will be required to perform in each state, and the large numbers of activities remaining to be performed—some close to the start of enrollment—suggest a potential for implementation challenges going forward. And while the missed interim deadlines may not affect implementation, additional missed deadlines closer to the start of enrollment could do so. CMS recently completed risk assessments and plans for mitigating identified risks associated with the data hub, and is also working on strategies to address state preparedness contingencies. Whether CMS’s contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined.”
That about sums up the whole report––CMS has been outwardly optimistic but is clearly struggling to make the deadlines.
While the GAO report gives us a clear sense of where CMS was as of about May, we are now essentially in the dark again. As the GAO report says, whether the exchanges will be ready or not now depends upon key dates between May and October.
Why can’t the administration build upon this report and keep us informed?
Some opponents of “ObamaCare” will take satisfaction in the problems the Obama administration is having getting this thing launched.
Let’s be clear, even if the launch has to be delayed or is just a mess at the start, this will eventually get launched and the Affordable Care Act will be central to the health insurance and health care system for years to come––under the best scenario for Republicans they won’t be able to repeal or fundamentally change the law until after Obama leaves office.
But, Democrats do need to be concerned about what a messy launch would mean to them in the November elections.
Health insurers, and proponents of the law, need to be worried about what a messy launch would do toward the goal of getting the healthy to sign up for coverage. If the healthy stay away from the exchanges out of concerns for administrative problems that could undermine the financial sustainability of the insurance reforms.
You can access the full report here.
You can also access the companion report on the small business (SHOP) exchanges here.
Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.