A new report from the General Accountability Office assesses the readiness of federally facilitated health insurance exchanges to be operational by Oct. 1, 2013, to support open enrollment for insurance coverage that starts in January 2014.

The Centers for Medicare and Medicaid Service is implementing exchanges in 34 states that have refused to do so themselves, although 15 of the balking states are expected to handle certain exchange functions, according to GAO, a congressional watchdog agency. The bottom line: “Whether these efforts will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” the GAO concludes.

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