A Government Accountability Office (GAO) report [PDF] last week found that the Obama administration and states have made progress in setting up health insurance exchanges under the Affordable Care Act (ACA), but many implementation activities are behind schedule.

Rather than scaring people, let’s focus on the real work needed to make sure that this reform continues to help the millions of Americans it’s intended to benefit.

Enrollment in the exchanges—the marketplaces in each state where individuals and small employers can shop for health coverage—is set to begin in October with coverage effective in January. For 2014, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) have granted conditional approval to 18 states to establish state-based Small Business Health Options Programs (SHOPs) and to 17 states to operate health insurance exchanges for individuals. CMS will operate a federally facilitated exchange in the remaining states.

GAO said that CMS has issued regulations and guidance necessary to establish the exchanges, but many activities remain to be completed in the core functional areas of eligibility and enrollment, plan management, and consumer assistance. CMS has timelines for completing these activities but in many cases is running behind schedule. For example, GAO said that development of a training curriculum that will provide outreach and enrollment assistance to small employers and their employees has been delayed by about two months.

GAO concluded that the large number of activities yet to be completed—some close to the start of enrollment—suggest “a potential for implementation challenges going forward.”

In response, HHS emphasized the progress that has been made to date and expressed confidence that, beginning October 1, exchanges will be open and functioning in every state.

Republican lawmakers seized on the GAO report to assert that the administration is ill-equipped to implement the exchanges under the timeline articulated in the ACA.

“What the GAO found is what most Americans have known all along: This law isn’t ready for prime time, and come October, millions of Americans and small businesses are going to be the ones suffering the consequences,” Sen. Orrin Hatch (R-UT), ranking member of the Senate Finance Committee, said in a statement.

Congressional Democrats said they aren’t surprised there is still work to do to implement a law of this complexity.

“As the president has said, there will be bumps in the road, but we will get there,” Rep. Jim McDermott (D-WA), ranking member on the House Ways and Means Subcommittee on Health, said in a statement. “Rather than scaring people, let’s focus on the real work needed to make sure that this reform continues to help the millions of Americans it’s intended to benefit.”

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