The Affordable Care Act public exchange system is heading toward its fourth annual open enrollment period with a fair amount of turmoil at the top.
Open enrollment for 2017 is set to start Nov. 1 and end Jan. 31. The exchange system is having to cope with insurers' concerns about how profitable covering its users really is, and ferocious competition from Medicaid and Medicaid-like programs.
The fate of Kevin Counihan, the head of the Centers for Medicare & Medicaid Services division that oversees HealthCare.gov, could depend on who wins the presidential election.
Either President Clinton or President Trump could tell Counihan, "You're fired."
Either could beg for him to stay on at least until the end of the open enrollment period.
Meanwhile, several of the state-based exchanges (and state-based exchanges that happen to use HealthCare.gov to handle the techy stuff) are going back into the fire with new chiefs.
For a look at three state-based exchanges undergoing changes at the top, along with videos related to those exchanges, read on.
Carolyn Quattrocki, Maryland's outgoing exchange chief, appeared in this promotional video for the open enrollment period for 2016 coverage. (Video: MarylandConnect/YouTube)
1. Maryland
Carolyn Quattrocki, an executive director who helped stabilize Baltimore-based Maryland Health Connect after it faced glitches and headlines about executive vacations, is leaving to become her state's deputy attorney general.
The Maryland Health Benefit Exchange board, the body that oversees Maryland Health Connect, has picked Jonathan Kromm to be acting executive director.
Kromm, who has been the deputy executive director, started out in policy research in Washington, D.C. at the American Cancer Society. He has a bachelor's degree in psychology from the University of Pennsylvania, and a doctorate in health policy and management from Johns Hopkins.
Here's a video featuring Bruce Gilbert from a Silver State Health Insurance Exchange board meeting that took place in January. (Video: Silver State Health Insurance Exchange/YouTube)