Hartford - As one of the states furthest along in preparing to enroll patients this fall in the new health insurance marketplace, Connecticut has discovered that being first comes with some challenges.

The staff at Connecticut's quasi-public exchange, known as Access Health CT, has had to build both an agency and an online health insurance marketplace from the ground up, relying on directives and guidance from the U.S. Department of Health and Human Services that can change or need to be clarified.

"Sometimes it feels like we're driving a car and then changing the tire at the same time," said Kevin Counihan, Access Health CT's CEO, in an interview with The Associated Press.

Late last month, Counihan said he informed HHS that Connecticut's exchange would have to stop implementing any new federal regulations as of March 1, in order to focus on getting ready for its user testing planned for June 4. He said the exchange will address any new regulations later.

Additional changes, Counihan said, could have a cascading effect on the complex online system, which will allow people to determine whether they qualify for a health plan discount, Medicaid or another insurance program.

It also allows them to shop for a qualified plan and ultimately enroll in a plan. If Access Health CT can't begin user testing on time because HHS now wants it to change a particular feature, Counihan said the exchange won't know where the bugs are in the system that need to be a fixed before enrollment begins.

Connecticut is one 17 states plus the District of Columbia that have been conditionally approved by HHS to operate state-based insurance marketplaces. Other states will partner with the federal government to run exchanges or let the federal government run theirs.

Connecticut is ahead of the pack when it comes to qualifying for federal funding. It is one of six states that already received five grants to build its exchange, according to HHS' website. Last summer, Connecticut received more than $107 million that's been used to hire staff and consultants and develop an information technology system that's expected to serve more than 100,000 people.

Counihan said HHS has been supportive of Connecticut's efforts to create the exchange, and he credits the federal agency with having a difficult task of creating a new system in a matter of months. The health care exchanges are the hallmark of President Barack Obama's federal health care overhaul.

"It's a three-year implementation being done in 10 months," he said. "And this is a huge challenge for everybody."

Counihan warned that Connecticut's exchange, which is supposed to be up and running on Jan. 1, won't be perfect. He predicted it will take three to four years to iron out problems. He also predicted it will take four to five years to reduce the numbers of uninsured to a very low level. But he said the exchange staff remains fully committed to the mission of expanding health coverage to as many people as possible.

In the meantime, the exchange plans to ramp up its efforts to reach out to those uninsured people.

Connecticut has received a $2.8 million federal grant to train people to personally help others enroll for coverage. The state has also signed up the Virginia-based government services company Maximus Inc. to run a new call center that will help people with enrollment.

Counihan said certain goals and objectives were included in the exchange's contract with Maximus, which has had a mixed history with the state. For example, he said, the company faces financial penalties if it does not perform adequately, such as resolving a specific percentage of first-time callers' questions or how quickly a call is answered.