The health-care law required states to set up the exchanges by October, giving the Department of Health and Human Services and Centers for Medicare and Medicaid Services the same time frame to establish a marketplace for firms in states that chose to leave the chore to the federal government.
Now, three months away, it appears those deadlines could be missed.
“Whether [the government’s] contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” the GAO concluded in dual reports last month, adding that “many activities remain to be completed and some were behind schedule.”
In the 17 states setting up their own exchanges, the report noted that nearly half of the key activities the government had intended to complete by the end of March had fallen behind. A program designed to educate employers and employees about the exchanges and how to enroll, for instance, is roughly two months behind schedule, according to the GAO.
Meanwhile, most states still must review plans proposed by insurers and train government workers to help business owners shop for coverage.
In Maryland, those and other technology-related challenges have prompted the state to push back enrollment three months to January 2014, when coverage sold on the exchanges was supposed to take effect. Instead, coverage under those plans will start in March.
Joshua M. Sharfstein, chairman of the Maryland Health Benefit Exchange board, said the decision to delay enrollment was a strategic one, noting that officials have been working with health-industry leaders to make the transition as smooth as possible for insurers, brokers and business owners. So far, 13 insurance providers plan to sell on the exchange.
“We are focusing on optimizing our partnerships with people who have a lot of experience selling plans to small businesses, and we felt the extra time would be well spent,” he said.
Still, the delay could drive down the number of firms that use the system next year, as employers whose current plans expire at the start of the year will have to renew or find a new plan before Maryland’s exchange is up and running.
Moreover, it appears even the new deadlines are not set in stone. Sharfstein said he expects the exchange to open for enrollment in January but stopped short of saying he was certain the department would meet that target.
“We do expect there to be bumps in the road,” Sharfstein said in an interview.