The GAO has issued two reports on the status of federal and state efforts to establish health insurance exchanges under the ACA. The first report discusses CMS efforts to establish federally-facilitated exchanges in 34 states that will not operate a state-based exchange for 2014.  A companion report examines federal and state efforts to implement insurance exchanges for small businesses, known as Small Business Health Options Programs, or SHOPs.  In short, the GAO concluded that while much progress has been made, much remains to be accomplished in a relatively-short timeframe in the areas of eligibility and enrollment, plan management (including certification of Qualified Health plans), and consumer assistance. The GAO could not determine whether CMS contingency planning “will assure the timely and smooth implementation of the exchanges by October 2013.”