Eight months after healthcare.gov's troubled launch, it seems that the Department of Health and Human Services' troubles aren't over yet. While the open enrolment period ended on a high note with 8 million Americans having signed up for insurance over the exchange, the federal and state exchanges still have ways to go before being ready to handle another open enrolment period without problems.

That is not to say that the passage and implementation of the Affordable Care Act hasn't already had positive effect on the state of the US healthcare.

Let's start with the positive.

More insured Americans, more spending on healthcare

The number of insured Americans is up, partly thanks to the Medicaid expansion. According to Gallup, newly insured represent about 4% of US adults. More Americans are going to see doctors and are spending money on their care, trying to meet the high deductibles that came with their new health insurance plans.

Some hospitals claim that they can already see the difference.

"We have seen a steady decline in our uninsured visits," said Roxanne Towndsend, CEO of University of Arkansas for Medical Sciences Hospital. The drop was especially evident in ER visits by uninsured patients, which went from 6,000 in early 2013 to 4,000 in the early 2014, according to Kaiser Health News. For hospitals, these drops in uninsured patients translate into more paying ones and, as a result, higher revenue.

Yet not all hospitals have seen such changes. Hospital Corporation of America (HCA) noted that in the states that did not participate in the Affordable Care Act expansion of Medicaid, its hospitals saw visits by uninsured patients increase by 6%. What's more, a number of Medicaid applicants from most states are still waiting for their initial application to be processed, according to a recent survey by CQ Roll Call.

The trouble with state exchanges

Then there are the downsides. The ACA websites for consumers are still, largely, an unholy mess.

Haunted by glitches of healthcare exchanges of the past, five states are about to spend as much as $240m to fix their sites or switch to the federal marketplace, reports the Wall Street Journal. Maryland, Massachusetts, Minnesota, Nevada and Oregon all need additional funds to fix the exchanges before the next enrolment period begins in November of this year. According to Journal's analysis, "the five states have already spend or committed to spend more than $700m in federal funds."

The need for fully functioning exchanges was underscored by the release of Health and Human Services slideshow presentation. The presentation revealed that about one in four people who have signed up for health insurance have discrepancies in their applications. "About 1.2m have discrepancies related to income, 505,000 have issues with immigration data, and 461,000 have conflicts related to citizenship information," reports the Associated Press.

The problem that many of these exchanges face is not just being up and running flawlessly come November, so that this doesn't happen again, but the fact that state marketplaces are required to sustain themselves come 2015.

Shifting priorities

While the administration is dealing with the Affordable Care Act rollout and its aftermath, certain things have become less of a priority.

Among the things that are falling by the wayside: audits of privately run Medicare Advantage plans. If medical facilities tell Medicare that patients are sicker than they really are, they can collect more in fees from the government – to the tune of billions of dollars in waste.

In the past, audits have revealed Medicare Advantage plans overbilling the government by exaggerating the ill health of their patients.

It all comes down to Medicare Advantage risk scores, which are indicators of how much care a patient will require – a high risk score indicates that a patient needs more medical care, and thus, likely more expensive hospital services.

By manipulating risk scores, which rate the overall health of each patient, the plans received $70bn in improper payments from 2008 to 2013, reports CPI.

However, there won't be people or money to find out how much the government may be losing.

"For the first two years of the Affordable Care Act rollout, officials have said there won't be audits to make sure that associated risk scores are accurate," said the Center for Public Integrity, CPI.

There were previous audits, which were conducted by office of inspector general for the Department of Health and Human Services. The IG's office will be working so intensely on ACA that it will take a two-year break from conducting audits of Medicare Advantage.

In the meantime, the Centers for Medicaid and Medicare Services, CMS, will continue to conduct audits of their own – on their own programs. It's not quite the same.

The audits, while helpful in identifying overpayments, are not quite as effective in recovering the money. According to CPI, one 2007 audit that found $41m in overpayments by a single health insurance company was settled for just $157,777. Despite their lack of teeth, the potential lack of IG audits is troubling seeing as it leaves CMS to audit itself.

CMS did not respond to request for comment as to how its audits differ from those of IG.

There is more of a bumpy road ahead for ACA as it continues its roll out, including improving the exchanges and implementing the employer mandate that has been previously delayed. The effects of the law that we have seen so far, whether bad or good, are just skimming the surface.