Republicans and Democrats warned Thursday that with major parts of President Obama's health law scheduled to go live later this year, the Obama administration had better get it right the first time -- or else risk permanently scarring the White House's signature achievement.
Health exchanges, which are designed to let those without employer-based insurance coverage shop for plans in a marketplace, are supposed to begin enrollment by Oct. 1 before activating at the start of 2014.
States that wished to partner with the federal government in running their exchange had to let the Department Health and Human Services know by Friday. About half of the states have opted for a federally run exchange, although they were free to submit a plan to partner with the federal government by the deadline.
Even as the last few states submit applications or -- in West Virginia's case, make up their minds -- lawmakers on Capitol Hill pressed an administration official on federal efforts to implement the contentious law with mere months to go before the uninsured can sign up for the exchanges.
Members of the Senate Finance Committee told Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, to make sure the exchanges' computer systems work, are easy to understand and can share enrollees' data across multiple federal agencies.
"You better be sure you get it right the first time, because if it crashes and burns on Oct. 1 you've got a huge problem," Sen. Johnny Isakson, Georgia Republican, said.
Mr. Cohen repeatedly assured Republican critics and committee Chairman Max Baucus, Montana Democrat, that the exchanges are on track and in the testing phase.
In tough questioning, Democrats made it clear that they support the Patient Protection and Affordable Care Act's overall mission -- extending health care to millions more Americans -- but wanted a detailed play-by-play of how the administration planned to implement the reforms.
Mr. Baucus said he would like to know about any "uh-oh revelations" that come up. He also demanded a list of benchmarks that Mr. Cohen hopes to meet in the coming months.
"We've got to get moving here," Mr. Baucus said. "We've got to know what we're doing and what we're not doing. We can't just talk -- it's deeds, not words."
Seventeen states and the District of Columbia have gained conditional approval to run exchanges on their own, according to HHS.
Although the administration encouraged states to set up their exchanges in-house, Kaiser Family Foundation data shows 26 states appear ready to distance themselves from any political consequences of the law by telling the federal government to set up an exchange for them.
Seven states -- Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West Virginia -- are planning to set up a partnership exchange with the federal government, according to the foundation.
Michigan Gov. Rick Snyder considered a partnership to be the "next best option" after the state legislature rejected his initial wish to set up a state-run market, spokesman Kurt Weiss said. The state submitted its plans to HHS this week.
New Hampshire Gov. Maggie Hassan announced her state's intentions Wednesday, the same day that HHS Secretary Kathleen Sebelius announced the department's conditional approval of Illinois' partnership exchange. Delaware and Arkansas also have obtained conditional approval.
Tim Albrecht, a spokesman for Iowa Gov. Terry Branstad, said the state submitted its plans for a federal-state partnership about a month ago.
"We wanted to maintain our independence in terms of our health care systems," he said, "but partner with the federal government where it made sense."
A spokeswoman for West Virginia Gov. Earl Ray Tomblin said Thursday that the state has not made a decision yet on its plans for an exchange.
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