The Government Accountability Office (GAO) has provided a status report on seven states’ efforts to establish health insurance exchanges — online marketplaces mandated by the ACA to enable eligible individuals and small business employers to compare and select health insurance coverage offered by qualified health plans. States can establish and operate an exchange themselves or partner with HHS, otherwise HHS will operate a federally-facilitated exchange for the state. As of March 14, 2013, 18 states had announced they would be establishing a state-based exchange, 7 states intend to partner with HHS, and HHS will establish a federally-facilitated exchange in 26 states. The GAO report provides details on the implementation efforts of the District of Columbia, Iowa, Minnesota, Nevada, New York, Oregon, and Rhode Island. Six of the states will operate a state-based exchange, while the seventh — Iowa — will partner with HHS. The seven selected states expect they will be ready for enrollment by the October 1, 2013 deadline, with health insurance coverage effective January 1, 2014. The report addresses the states’ efforts to: decide which QHPs will be included in the exchange; develop an information technology infrastructure; implement a consumer outreach and assistance program; and sustain their exchange financially.