The U.S. Department of Health and Human Services and state agencies are already starting to issue regulations and guidelines for the 2015 public exchange program.
Many states have had trouble getting 2014 exchange enrollment systems to work properly. Oregon, for example, has not yet completed work on its enrollment site, and Covered California has set up the small-business coverage sales section of its site just this week.
Officials at HHS and the Centers for Medicare & Medicaid Services have been trying to soften President Obama's recent promises that the government would get the HealthCare.gov federal exchange enrollment site working properly by Nov. 30.
But CMS has started to seek comments on a draft version of an actuarial value calculator that health plans, employers and actuaries could use in PPACA-related calculations in 2015.
Meanwhile, states are developing strategies for making state-based exchanges "self-sustaining."
PPACA provides startup and first-year funding for state-based exchanges but requires the exchanges to sustain themselves with their own revenue, or local government support or other support, starting in 2015.
HHS has proposed funding the federally run exchanges with an exchange insurer user fee equal to 3.5 percent of exchange plan premium revenue.
The District of Columbia Health Benefit Exchange Authority is seeking comments on a report that calls for the authority to levy a licensing fee and collect a "broad-based assessment on all health insurance premiums in the district" from non-group, small group, large group and Medicaid managed care carriers.