Lawmakers Question CMS Support of State Insurance Exchanges

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The Government Accountability Office will examine the role of the Centers for Medicare and Medicaid Services in helping state health insurance exchanges transition from state-based information systems to the federal program. The House Energy and Commerce Committee requested the study.

The Affordable Care Act authorized CMS to provide federal grants to states for planning and establishing their own health insurance marketplaces, including websites and related IT systems. However, with about $5.5 billion in Obamacare grants already awarded to states, Republican leaders of the committee are concerned whether states will be able to financially sustain their marketplace IT systems, putting further taxpayer dollars at risk.

According to the GOP lawmakers, the roll-out and operation of the state marketplaces have been plagued with technical problems—such as frozen or crashed websites—which have hindered or prevented consumers from enrolling in healthcare coverage.

As open enrollment officially came to a close March 31, there have been many milestones on the way. Here are ten key dates, in reverse order, on how we got to where we are.
March 31

“Consequently, a number of states that struggled with their IT implementation are now using the federal IT platform to allow consumers to enroll,” according to the committee letter to Gene Dodaro, comptroller general of the United States and head of the GAO.

Specifically, committee members cite that four states—Hawaii, Nevada, New Mexico, and Oregon—have “chosen this course for one or more years of marketplace coverage” despite the fact that the ACA required state-based marketplaces to be self-sustaining beginning January 1, 2015, and prohibited CMS from awarding exchange grants after December 31, 2014.

“In the absence of federal funds to support state marketplace operations, questions remain as to whether states will be able to financially sustain their marketplace IT systems. Given the significant federal investment in these state marketplaces, and the unavailability of federal grant funds to support state marketplace operations, we are requesting that the Government Accountability Office examine and report on this issue,” concludes the letter.

Lawmakers want GAO to address the following questions:

  • What, if any, assistance has CMS provided to guide states that choose to transition to a different marketplace IT platform, and what are the associated costs and challenges for states in making this transition?
  • What, if any, assistance has CMS provided to guide states’ efforts to financially self-sustain any future marketplace IT systems development and operations and what are selected states’ plans for self-sustainability?
  • What, if any, role has CMS taken or planned to oversee and monitor the operation and performance of states’ marketplaces in the absence of federal grant funds?

A CMS spokesperson declined to comment on the committee’s concerns and GAO request.

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