“There is really nothing new in this GAO report,” says Dan Mendelson, CEO of Washington, D.C.-based consultancy Avalere Health, referring to the report on CMS' efforts to establish exchanges in 33 states that have asked for federal help in doing do. “It's actually very complimentary of CMS,” as it mentioned the agency has met project schedule deadlines.
That report was requested by Sen. Orrin Hatch (R-Utah) and Reps. Darrell Issa (R-Calif.) and Fred Upton (R-Mich.). The other report dealt with federal and state efforts to establish small business exchanges, known as Small Business Health Options Program, or SHOP, exchanges, and was requested by Rep. Sam Graves (R-Mo.), who chairs the House Small Business Committee. GAO found that while progress has been made in both exchange types, more work needs to be done within a relatively short period of time.
Mendelson adds that the GAO appears “nervous” about the completion of final testing of the federally facilitated exchanges and the ability for state exchanges to interact with the federal data hub, the IT system that will make subsidy and Medicaid determinations.
But, he notes, with the launch of a project the size of online insurance marketplaces in each state, it should be expected that preparations could come down to the last minute.
“I see this as nervousness about a complex system,” Mendelson says. “The nervousness is warranted, but the political histrionics are not.”
Mendelson's comments were echoed by Tim Jost, a professor at Washington & Lee University School of Law and a nationally recognized authority on the health reform law, who says that CMS has been progressing well with exchanges, despite obstacles thrown in its way.
“It is amazing that they have gotten this far given the fact that the Republicans in Congress have starved them of resources and harassed them constantly with redundant and politically driven oversight hearings,” he says. “Refusal of many states to cooperate has greatly complicated their task. The news here is that despite these obstacles, HHS is getting close to the finish line.”
But Robert Laszewski, a former insurance executive and president of Health Policy and Strategy Associates, a consulting firm, is not as optimistic. In a blog post today, he writes that the report on CMS readiness is largely contingent on meeting milestones between now and October.
And whether the launch of exchanges goes smoothly or not could have political repercussions. “Republicans 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.”
Follow Jonathan Block on Twitter: @MHjblock