The federal government still has a lot of work to do to improve the performance of the 14 state-run health insurance exchanges that were set up as part of the Patient Protection and Affordable Care Act.
In a report, the Government Accountability Office outlines a number of IT weaknesses that continue to prevent the system from meeting full expectations. However, much of the information upon which the report is based is not up-to-date.
The audit reports, for instance, that as of November 2014, 7 of 37 states using the federally-run insurance marketplace were either not able to transfer health insurance applications between the state-run Medicaid system and a key component of the federal marketplace or had not tested their systems to see if they could do it.
The report lays much of the blame on the Centers for Medicare and Medicaid Services (CMS), the federal agency tasked with overseeing the implementation of the PPACA and its nationwide network of insurance exchanges. As it did in a similar report detailing CMS' failure to set up a Healthcare.gov in time, the GOA criticized CMS for not establishing more clearly-defined roles for officials overseeing the PPACA.
"Because roles and responsibilities were not always clearly defined, documented or communicated, as recommended by leading practices for project management, a number of states faced hurdles in communicating with CMS," the report states.
The report also notes that a number of states have not kept track of the money they've spent so far to build their marketplaces. So far, states have spent a combined $1.45 billion in federal funds setting up IT systems to support their insurance exchanges. The great majority of that spending came from the 14 states that chose to set up their own exchanges.
None of the 14 state exchanges were rated as "fully operational" on four key measures. Vermont, rated operational on three of the four, earned the highest marks overall.
Ironically, Vermont's exchange has struggled mightily and has sparked widespread outrage among residents of the deeply Democratic state. In fact, the challenges the state faced in implementing the PPACA stopped Gov. Peter Shumlin from pursuing a more ambitious goal of setting up the nation's first single-payer system.