In theory, ObamaCare's health exchanges will be up and running, enrolling new people before the end of the year. Fewer than half the states will be running their own exchanges, and so the Department of Health and Human Services has stepped in to run the rest. In recent months, however, a number of health policy observers have openly questioned the ability of the federal government to get ObamaCare's health insurance exchanges up and running by the end of the year. That might explain why HHS has been so willing to waive and extend exchange creation deadlines for state.
HHS insists that the federally run exchanges will be online on time, but it has also continued to delay state implementation deadlines in a way that could suggest the agency is not quite as ready as it claims to be. That makes the following passage from the new federal budget baseline published by the Congressional Budget Office this afternoon rather, well, interesting:
CBO and JCT [Joint Committee on Taxation] have slightly reduced their estimates of the rates at which people will enroll in the insurance exchanges or Medicaid as the expansion of coverage is implemented—a process that had already been anticipated to occur gradually. That change reflects the agencies’ judgment about a combination of factors, including the readiness of exchanges to provide a broad array of new insurance options, the ability of state Medicaid programs to absorb new beneficiaries, and people’s responses to the availability of the new coverage.
So is the CBO skeptical that the federal exchanges will be ready on time? That certainly seems possible, although the report does not specify whether it's uncertain about the readiness of federal exchanges as opposed to state exchanges, nor does it clearly indicate what its readiness concerns are.
HHS Secretary Kathleen Sebelius seems a bit concerned about the pace of implementation herself. At a health policy conference in Washington, D.C., yesterday, she declared ObamaCare the law of the land and asked for help making it work: "My challenge to all of you today, and actually my plea to all of you...is help us speed up the rate of change.”