Wednesday, June 19, 2013

Will the Affordable Care Act's ("ObamaCare") Federal Health Insurance Exchanges Be Ready On Time? Finally the Facts!

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. "
Re 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.
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