A delay in implementation of the Affordable Care Act is creating uncertainty among states and health insurers tasked with creating health insurance exchanges. The delay has raised questions about whether the exchanges will be ready to enroll individuals on October 1, 2013, and how many plans will be available.

At least half a dozen rules regarding the exchanges are not listed on the White House Office of Management and Budget website that tracks which regulations federal budget officials are reviewing. The unlisted rules include:

  • Rules governing state insurance markets;
  • Rules on federally run exchanges;
  • Regulations on essential health benefits;
  • A notice concerning benefit and payment provisions, including risk-adjusted payments;
  • Rules on establishing the actuarial value of plans sold in the exchange; and
  • Rules on exchanges regarding appeals of eligibility determinations and oversight of health plans.