Implementing Health Reform: A GAO Progress Report On The Exchanges

One June 19, 2013, the Government Accountability Office (GAO) released a report examining the Center on Medicare and Medicaid Services (CMS) efforts to establish federally facilitated health insurance exchanges (FFEs) and a companion report analyzing federal and state efforts to establish health insurance exchanges for small businesses, or SHOP exchanges. I do not normally blog about government reports, but the GAO reports are the best windows we have had so far into the frustratingly opaque process of CMS exchange implementation. I do not intend to describe the reports in their entirety, as much of their content is already well understood by readers of the Health Affairs blog. This post, however, will cover the new information found in the reports. The GAO reports were greeted with glee by Republican congressmen opposed to the ACA. “The law is indeed a train wreck with no relief in sight,” said Congressman Sam Graves. But, viewed in another light, the reports document the remarkable progress that CMS has made toward ACA implementation despite the formidable obstacles it has faced. Under the best of circumstances, creating and implementing a program that will revolutionize the way in which individual and small group health insurance is underwritten and sold in the United States, providing financial assistance through the tax system and Medicaid to millions of Americans who cannot afford health insurance, and organizing health insurance markets to promote choice and...
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