Leaders of insurance exchanges fear time is running out for testing

The heads of two state-run health insurance exchanges say they are concerned that there may not be enough time for testing the marketplaces before open enrollment begins Oct. 1.

An endeavor as complex as establishing an exchange would normally take three years, Kevin Counihan, CEO of the Connecticut Health Insurance exchange said Monday during a panel discussion of the World Health Care Congress in National Harbor, Md. Under federal guidelines, the work must be done in a 10-month period.

As the Oct. 1 enrollment deadline nears, Counihan said, he is unsure about the status of the federal data services hub. The hub is critical because it is responsible for verifying information that consumers provide when they apply for coverage, such as income status, which will determine subsidies and Medicaid eligibility.

Counihan also expressed reservations about "navigators," the grant-funded companies and not-for-profit organizations that will help consumers fill out application forms and answer questions about the exchanges. He said he is still waiting for the federal money to fund the navigator program.

The work building the state exchanges is likely to continue long after Oct. 1 comes and goes.

Richard Onizuka, CEO of the Washington State Health Benefit Exchange, said he is confident his state's exchange will be ready to begin enrolling residents in October, but things may be bumpy at the outset.

The Web portal to the exchanges that will be operational at the start will have several key features up and running. In real time, after inputting personal and financial information, an applicant will find out if they qualify for Medicaid or subsidies. When the consumer then shops for a plan, the premium amount will then reflect any subsidies.

That's real progress; Medicaid determinations in Washington currently take up to 45 days. The exchange, though, “will be a work in progress on Oct. 1,” Onizuka said. “A lot of things we would like to be in it (initially) will be in later versions of the exchange.”

One challenge Washington still faces, for example, is how to deal with people who will alternate between being eligible for Medicaid and being directed to the exchange. Onizuka said he hopes carriers will offer the same plans on both exchanges and for Medicaid enrollees—nearly all of whom are in managed-care plans administered by private carriers.