Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.
If the states don't do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.
The White House just released a report saying that good progress is being made in 28 states. That begs the question, what about the other 22?
Writing in Kaiser Health News, Julie Appleby recently reported that that HHS has let just two contracts toward building the federal fallback exchanges. One is for $69 million to build the data hub so that federal agencies can share data with the exchanges--the IRS for example. The other contract is more directly related to building federal fallback exchanges, a $94 million contract.
But in their progress report today, the administration said that they have already advanced $729 million to the states for exchange construction––17 of those states receiving $1 million, or less. So, more than $700 million has gone to 33 states--and that is just federal money to date.
If the feds are going to be ready to launch 10 or 20 federal fallback exchanges these numbers just don't compute. It is going to take a lot more than the $94 million HHS has contracted for to launch that many federal exchanges in the states that refuse to do so.
HHS says they will be ready. But they have been awfully secret over just how they are going to have lots of exchanges ready to go in 20 months. It is hard to see how that $94 million contract is more than just a down payment.
Whatever the threats are to the Affordable Care Act from the 2012 elections and the Supreme Court ruling expected by July, the market has no choice but to spend lots of money and resources toward being ready on October 1, 2013. HHS has an obligation to tell the market more than "don't worry about us." Market players are investing considerable resources and deserve to see the plan.
Right now, the numbers don't compute--the number of states that could well not be ready, the federal money being spent by states that say they will offer exchanges, and the much less money HHS admits to be spending for those that will not be ready.
Where's the plan?
Robert Laszewski blogs regularly at the Health Care Policy and Marketplace Review.