The 14 states that chose to run their own exchanges had basically the same pool of contractors as HHS — along with a supply of federal grant money, the same deadlines, and the same underlying law, Laszewski said.
"There's only one variable — who's running it," he said.
It's also hard to ignore the fact that some of the most troubled state-run exchanges signed big contracts with CGI — the company that's in the hot seat over HealthCare.gov's failures. The Canadian company was the primary contractor for new marketplaces in four states: Colorado, Hawaii, Massachusetts, and Vermont.
Health care experts consider Hawaii one of the worst state-run exchanges in the country. It only began to display information about health care plans last week, a full 15 days behind the Oct. 1 deadline.
In Vermont, consumers can compare their policies online, but they can't actually buy one. State officials delayed the sign-up process until at least November, because their testing showed that the technology simply didn't work.
"I think I've made my frustration with what doesn't work very clear," Vermont Gov. Peter Shumlin, a Democrat, said this week, according to a local newspaper. "It's frustrating. When we pay for a product I expect it to work. I've made that very clear to the CEO of CGI, I'm going to hold their feet to the fire until it's perfect."
Colorado got off to a rough start as well, although its site appears to be improving. Just 305 people had signed up for coverage through Colorado's exchange a week after it opened.
It is unclear whether CGI's clients faced delays because of problems with the company's work. A source familiar with the state exchanges said delays in Hawaii and Vermont were caused by the compressed time frame of the contracts — the company had 10 months to finish its work in Hawaii and less time in Vermont — and the ambitious nature of the projects.
Ultimately a contract with CGI may not be the deciding factor in an exchange's success or failure. The company was a subcontractor for Kentucky's successful exchange, although it built different parts of the system there.
Before the Oct. 1 launch date, all eyes were on states like Maryland and California — solid blue states where Democratic governors enthusiastically embraced the Affordable Care Act and made clear that they intended to be leaders in the implementation effort.
States like Kentucky ended up faring better in part because they built smaller, more efficient systems rather than aiming for a dramatic new marketplace full of bells and whistles, an insurance industry official said.
Kentucky also credited its success with the fact that it built the exchange within an existing state agency, keeping the operation small and focused.
"We kept the design as clean as possible to ensure fast load times and we made sure the content was only what was necessary and written at a very low reading level — keeping the process as simple as possible was our guiding principle," said Gwenda Bond, a spokeswoman for Kentucky's Cabinet for Health and Family Services, which built the exchange.