"To date, most payers haven't received much information from the state HIXs, and this is incredibly problematic for those insurers planning to participate in 2014. They have IT system and business process changes to implement to ensure they are ready on day one, and those changes depend on information," says Gier.
That uncertainty bears out in the survey, which shows a significant number of survey respondents—70%—saying they feel confident that they are prepared or will be prepared for open enrollment in October, but their confidence does not extend to the readiness of the federal government or other exchange models.
Only 29% reported being certain that the exchanges would be ready to launch October 1. Overwhelmingly, 70% indicated concern over the issue of whether exchanges would be ready to enroll millions of Americans who are expected to use the exchange to find insurance.
Gier says states and insurers can learn from Colorado and Washington. She holds them up as good examples of seamless collaboration with the insurers in their states, saying they took a "share early, share often" approach with payers.
Another reason insurers have doubts about the federal and state readiness is likely due to the rolling deadlines for several key components needed to build an HIX, including states committing to one of three models: state-run, state-federal partnership, and federally run.
The Centers for Medicare & Medicaid Services (CMS) extended the deadline for states at least twice, and even now, if states wanted to change models they could. The federal government did not envision running most of the exchanges and some states may be poised to take advantage of the government's willingness to hand off some of the responsibility.