A Million Things Could Go Wrong. and Did
Carmody, Tim, Newsweek
Byline: Tim Carmody
There was a lot riding on Healthcare.gov.
The site has to do many things: verify a person's identity, legal residence, and income; record his personal information; match him with health insurance plans for which he is eligible; calculate whether he's eligible for a subsidy (and how much); help him compare plans by costs and features; and, finally, enroll him in a plan.
Enrolling in any insurance plan can be tricky; comparison-shopping for one in a state that may offer hundreds is a daunting task. It requires working with all 50 states (the exchange may be federal, but the insurers aren't) and dozens of insurers.
What's more, since the Affordable Care Act was designed to support state exchanges, parts of the site's spine - specifically the data hub that pings the IRS, Social Security Administration, the Department of Homeland Security and credit bureaus - has to work with each state's websites, federal departments, and credit agencies. That's a staggering data and software challenge.
A lot could go wrong and did. Here's the story of how it happened.
Like every modern website that has to make something happen rather than just display text, Healthcare.gov separated its site into a front-end that interacts with the customer and a back-end that (among other things) fetches and matches data and moves your information through the system. But unlike most enormous modern websites that make things happen - Google, Facebook, Amazon - Healthcare.gov divided this work among a variety of companies. For obvious reasons, there is no company with experience building a federal health insurance exchange.
The most important of the companies running the back-end are CGI Federal, which built the insurance marketplaces, as it had for state Medicaid programs, and QSSI, which built the data hub to verify citizens' eligibility. The homepage is by Development Seed, a small, young D.C.-based company that came in as a subcontractor under Aquilent, which navigated the bureaucracy and bid for the contract. "If I were to bid on the whole project," Development Seed's Eric Gundersen told Slate's David Auerbach, "I would need more lawyers and more proposal writers than actual engineers to build the project. Why would I make a company like that?"
The entire project was overseen by the Centers for Medicare and Medicaid Services (CMS), part of the Department of Health and Human Services. CMS wasn't a software company, and had no experience running a project this large, but some government agency had to be in charge. CMS was also busy monitoring and coordinating the development of all the state exchanges.
Keep in mind that when the Affordable Care Act was passed and the government contracts were doled out, Healthcare.gov was a relatively tiny piece of the overall health exchange pie. The real plums were the state exchanges: There were more of them, and most of them paid more money. CGI's contracts to run exchanges in Colorado, Massachusetts, Vermont, and Hawaii were worth more than twice as much as its contract for Healthcare.gov ($71 million); New York's exchange was worth $183.6 million for Computer Sciences Corp., and California's $359 million for Accenture. Healthcare.gov wasn't supposed to be the primary end-to-end portal for citizens seeking health care.
It was supposed to be no big deal.
To understand how Healthcare.gov misfired, look at how it came about. The site is fundamentally a compromise between two increasingly polarized groups: government bureaucrats and software developers. In an attempt at moderation and to foster unity, the Obama administration tried to bring those two groups together, blending ideas from both sides, even as experienced bystanders warned that the two were incompatible. The result is a complicated mess, only capable of lurching from crisis to crisis. The only thing worse than the reality is the rhetoric, as both sides point fingers. …