Two GAO reports reveal that health insurance exchanges – websites where consumers and employers can shop for healthcare insurance – could miss their Oct. 1, 2013 deadline. However, Department of Health and Human Services officials said in a response published in the reports they were confident the exchanges would be open and functioning in every state by the target date.

The exchanges, required under the federal health reform law, are expected to provide healthcare coverage for 7 million people in 2014, and 22 million by 2016.

One report examines efforts by the Centers for Medicare & Medicaid Services; the other explores how far along state and federal governments are in the process.

“Much progress has been made, but much remains to be accomplished within a relatively short amount of time,” the government watchdog states in both reports.

[See also; Insurance exchange rule unveiled.]

CMS will operate a health insurance exchange in the 34 states that will not operate a state-based exchange for 2014. Of these 34 federally facilitated exchanges, 15 are in states expected to assist CMS in carrying out certain functions. However, the activities that CMS plans to carry out in these 15 exchanges, as well as in the state-based exchanges, have evolved and may continue to change, according to GAO.

For example, CMS approved states' exchange arrangements on the condition that they ultimately complete activities necessary for exchange implementation. CMS indicated that it would carry out more exchange functions if any state did not adequately progress towards implementation of all required activities.

GAO noted that many key activities, such as how to determine eligibility, the enrollment process, plan management and consumer assistance remain to be completed, and some are behind schedule. For plan management, CMS must review and certify the qualified health plans.

“While the missed interim deadlines may not affect implementation, additional missed deadlines closer to the start of enrollment could do so,” GAO said.

State-based exchanges
CMS granted conditional approval to 18 states to establish state-based Small Business Health Options Programs, or SHOPs, and to 17 states to operate health insurance exchanges for individuals. Again, GAO found much remained to be done.

While CMS has established timelines for completion of these activities, some were behind schedule, GAO pointed out.  For example, funding awards and development of a training curriculum for a key program that will provide outreach and enrollment assistance to small employers and employees have been delayed by about two months.

[See also: HHS allots $241M for state insurance exchange IT.]

With regard to the states, CMS data showed that most had completed preliminary activities such as obtaining the necessary authority to operate an exchange, and many had made progress in each of the core functional areas. Many key activities remained to be completed – some scheduled for near the start of enrollment in October 2013. However, about 44 percent of the key activities CMS initially targeted for completion by March 31, 2013, are behind schedule.

CMS reported that it had revised many target dates and other delays were not expected to affect exchange operations.