“I’m going to try and download every movie ever made, and you’re going to try to sign up for Obamacare, and we’ll see which happens first” – Jon Stewart challenging Kathleen Sebelius (former Secretary of Health and Human Services) to a race.
The affordable care act (increasing healthcare access to all Americans), signed by President Obama on 23 March 2010, required that the United States Department of Health and Human Services (HHS) launch HealthCare.gov on 1 October 2013. This website going to be the official health care exchange that would allow residents to compare prices of health care plans, identify if they qualify for federal subsidies, and enroll in a chosen plan. The Affordable Care Act gave states the right to create their own healthcare exchange or opt-in to the federal exchange (healthcare.gov).
Healthcare.gov was officially launched on 1 October 2013 covering residents of 36 states that did not create and manage their own healthcare exchange. Problems with the website were apparent immediately. High website demand (250,000 users [5 times more than expected]) caused the website to go down within 2 hours of launch. While website capacity was initially cited as the main issue, additional problems arose mainly due to the website design not being complete. Users cited issues such as drop down menus not being complete and insurance companies cited issues with user data not being correct or complete when it reached them.
In addition, the websites login feature (which is the first step to accessing the website) could handle even less traffic than the main website which created a huge bottleneck. Due to poor planning, this same log in method was also used by website technicians, making it extremely difficult for them to log in and troubleshoot problems.
A total of 6 users completed and submitted their applications and selected a health insurance plan on the first day.
Through a large amount of troubleshooting, bringing in new contractors, and increased management, the website could handle 35,000 concurrent users at a time by December 1 and a total of 1.2 million customers signed up for a healthcare plan by 28 December, when the open enrollment period officially ended.
The myriad of problems experienced during the websites rollout were due to several factors, primarily:
- Lack of relevant experience. HHS employees and managers had a lot of experience with private insurance markets and maintaining large government projects, but did not have required experience in technology product launches. Key technical positions were unfilled and project managers had little knowledge on the amount of work required and typical product development processes leaving very little time to test and troubleshoot the website.
- Lack of leadership. There was no formal division of responsibilities in place between the many government offices involved which caused a delay in key decision making or a lack of communication when key decisions were made. For example, the contractor responsible for the log on system estimated a low demand because the initial website plan included the option to shop for products without creating an account or logging in. However, due to technical delays, that functionality was removed from the initial website launch (so all users would need to log in) without increasing capacity.
- Schedule pressure. Since the launch date was mandated in the Affordable Care Act, HHS employees were pressured to launch on time regardless of completion or the amount (and results) of testing and troubleshooting performed.
The key issues discussed above resulted in the rollout of the healthcare.gov website ballooning the initial $93.7M budget to an ultimate cost of $1.7B.
It is easy to observe that the launch of healthcare.gov was a major failure, but this isn’t a particularly unique case. Research has shown that over the past 10 years, 94% of large federal information technology projects were unsuccessful, more than 50% were delayed, overbudget, or didn’t meet expectations and a total of 41.4% were judged to be complete failures. I contend that most of the root causes identified for healthcare.gov are not unique and it is not a surprise the federal government struggles with adapting to new technology. A large, bureaucratic organization that has significant experience in core government policies is likely not adaptable to behaving like a “start-up” and successfully launching new technology.
Based on the number of government organizations that all have policy experience and will likely have to adapt to technology challenges in the future, the government should either create a new government office strictly responsible for handling technology products for the rest of the government or make a significant investment to ensure that all government offices have the experience, management tools, and resources required to integrate technology into their offices.
1 – Office of Inspector General, HealthCare.gov: CMS management of the federal marketplace: a case study, Available at: https://oig.hhs.gov/oei/reports/oei-06-14-00350.pdf [Accessed November 18, 2016].
2 – Goldstein, A., 2016. HHS failed to heed many warnings that HealthCare.gov was in trouble. Washington Post. Available at: https://www.washingtonpost.com/national/health-science/hhs-failed-to-heed-many-warnings-that-healthcaregov-was-in-trouble/2016/02/22/dd344e7c-d67e-11e5-9823-02b905009f99_story.html [Accessed November 18, 2016].
3 – Healthcare.gov. Wikipedia. Available at: https://en.wikipedia.org/wiki/Healthcare.gov [Accessed November 18, 2016].
4 – Johnson, C. & Reed, H., 2013. Why the Government Never Gets Tech Right. The New York Times. Available at: http://www.nytimes.com/2013/10/25/opinion/getting-to-the-bottom-of-healthcaregovs-flop.html [Accessed November 18, 2016].