Difference between revisions of "Healthcare.gov website rollout"
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===GAO investigation results===
===GAO investigation results===
The Government Accountability Office (GAO) investigated the costs of the ''Healthcare.gov'' federal exchange website, estimating that the total cost, as of March 2014, was $840 million.<ref>[http://online.wsj.com/articles/poorly-managed-healthcare-gov-construction-cost-840-million-watchdog-finds-1406751529 ''Wall Street Journal'', "Poorly Managed HealthCare.gov Construction Cost $840 Million, Watchdog Finds," July 30, 2014]</ref> GAO Director of Acquisition and Sourcing Management William Woods claimed that the overrun was due to inconsistent oversight and constantly changing requirements, which were noted by contractors when asked to testify during the
The Government Accountability Office (GAO) investigated the costs of the ''Healthcare.gov'' federal exchange website, estimating that the total cost, as of March 2014, was $840 million.<ref>[http://online.wsj.com/articles/poorly-managed-healthcare-gov-construction-cost-840-million-watchdog-finds-1406751529 ''Wall Street Journal'', "Poorly Managed HealthCare.gov Construction Cost $840 Million, Watchdog Finds," July 30, 2014]</ref> GAO Director of Acquisition and Sourcing Management William Woods claimed that the overrun was due to inconsistent oversight and constantly changing requirements, which were noted by contractors when asked to testify during the website rollout.<ref name="CBSoverrun">[http://www.cbsnews.com/news/healthcare-gov-has-already-cost-840-million-report/ ''CBS News'', "HealthCare.gov has already cost $840 million," July 30, 2014]</ref>
Revision as of 11:04, 1 August 2014Patient Protection and Affordable Care Act (ACA or commonly referred to as Obamacare). The federal website is intended to provide insurance options and administer government subsidies for residents of 36 states.
The English-language version of Healthcare.gov website went live on October 1, 2013. The launch of a Spanish-language version has been delayed.
The website exists in order to enable users to shop for health insurance plans online and determine eligibility for subsidies (or for Medicaid enrollment at lower income levels). The enrollment period opened October 1, 2013, the same day the government shut down over the budget debate.
The open enrollment period ended on March 31, 2014. The penalty, payable to the federal government, for not being enrolled in a health insurance plan by March 31 is either $95 or 1% of income, whichever is greater. The White House stated anyone selecting a plan before the deadline would not be subject to the penalty. In March 2014, however, the administration announced that uninsured people were allowed to enroll in plans into April as long as they had a plan selected on the website by March 31.
- 1 Website usage
- 1.1 Number of website visitors
- 1.2 Number of enrollees
- 1.2.1 March/April enrollment official report
- 1.2.2 February enrollment official report
- 1.2.3 January enrollment official report
- 1.2.4 December enrollment official report
- 1.2.5 November enrollment official report
- 1.2.6 October enrollment official report
- 1.2.7 Early enrollment estimates
- 1.2.8 FOIA request filed by media outlets
- 1.3 Type of enrollees
- 2 Project benchmarks
- 3 Pre-launch testing
- 4 Issues with rollout
- 4.1 New accounts and logging in
- 4.2 Data transfer problems
- 4.3 Errors in price quotes
- 4.4 Direct enrollment
- 4.5 Transfers from Medicaid
- 4.6 Data hub outages
- 4.7 Website outages
- 4.8 Security concerns
- 4.9 Manual back-up systems
- 4.10 State exchange enrollment problems
- 5 Why did problems happen?
- 6 Efforts to fix
- 7 Penalties
- 8 Costs
- 9 Contractors
- 10 Public opinion
- 11 Congressional hearings
- 12 Sebelius resignation
- 13 Possible ramifications
- 14 International government-run healthcare IT comparisons
- 15 Alternatives to Healthcare.gov for insurance
- 16 Reactions
- 17 Recent news
- 18 See also
- 19 External links
- 20 References
The rollout date was met with high demand for the website, both by those seeking insurance and those curious to see how the site worked. Attempts to use the website have resulted in errors, including:
- Error messages while creating an account and trying to log in
- Data transfer problems from the exchange to healthcare providers
- Errors in price quotes when not logged in
- Lack of ability to sign up directly through individual insurance providers
In an October 30, 2013, hearing before the House Energy and Commerce Committee, Health and Human Services Secretary Kathleen Sebelius stated, "Hold me accountable for the debacle. I’m responsible."
The first official report from the Obama administration was released November 13, 2013, covering October enrollment numbers. The report stated 26,794 users completed enrollment through the Healthcare.gov federal exchange. Another 79,391 users were able to enroll in the 15 state exchanges, bringing the total enrollment to 106,185 in October. Prior to rollout, the administration estimated 500,000 would sign up in the first month.
On November 22, 2013, the Obama administration announced an 8-day extension on completing applications for coverage starting January 1, 2014. The deadline to complete the application was moved from December 15 to December 23, 2013. Additionally, the 2014 open enrollment period has been pushed back from the original October 15 start date to November 15, 2014, just after midterm elections. On November 25, 2013, the administration announced the Small Business Health Options Program (SHOP) would be delayed by one year. The program was supposed to be rolled out in October 2013 but was delayed until November 2014. Employers seeking the tax credit before the federal exchange rolls out SHOP in 2014 must use an insurance broker to sign up for eligible plans. The small business program delay does not impact states with state-run exchanges.
The federal government expected that seven million Americans who were previously uninsured wwould buy a health insurance plan by March 31, 2014. The White House hoped to have about 2.7 million of the enrollees be young adults in order to offset the costs of insuring those with pre-existing conditions. The administration expected about 500,000 enrollees by the end of October 2013, but only 106,185 were enrolled.
According to Jeffrey Zients, the leader of the administration's "tech surge," on October 25, 2013, the success rate of those attempting to create an account was up to 90%, but there were still problems completing applications, where "As few as three out of 10" were accepted.
Number of website visitors
- The official HHS report released May 1, 2014, noted the number of unique visitors to the state and federal exchanges was 98.3 million. The number of calls to the call centers was 33.3 million.
- The official HHS report released March 11, 2014, noted the number of unique visitors to the state and federal exchanges was nearly 75 million. The number of calls to the call centers was over 19 million.
- The official HHS report released February 12, 2014, noted the number of unique visitors to the state and federal exchanges was nearly 64 million. The number of calls to the call centers was 16 million.
- The official HHS report released January 13, 2014, noted the number of unique visitors to the state and federal exchanges was 53.2 million. The number of calls to the call centers was 11.3 million.
- The official HHS report released December 11, 2013, noted the number of unique visitors to the state and federal exchanges was 39.1 million. The number of calls to the call centers was 5.2 million.
- The official HHS report released November 13, 2013, noted the number of unique visitors to the state and federal exchanges was 26,876,527. The number of calls to the call centers was 3,158,436.
- As of October 21, 2013, the website had had 20 million visits.
Number of enrollees
March/April enrollment official report
The official report for the closing of the open enrollment period was released May 1, 2014. Below are some notes from the report:
- At the conclusion of the open enrollment period, 8,019,763 users had selected a plan. Of those signups, 5,446,178 signed up through the federal exchange.
- Of the signups, 34% were age 34 and under, while 48% were between the ages of 45 and 64.
February enrollment official report
The official report for February enrollment was released March 11, 2014. Below are some notes from the report:
- Through the first five months of the six month enrollment period, 4,242,325 users had selected a plan. Of those signups, 2,621,086 signed up through the federal exchange.
- Of the signups, 31% we age 34 and under.
January enrollment official report
The official report for January enrollment was released February 12, 2014. Below are some notes from the report:
- Through the first four months of the six month enrollment period, 3,299,492 users had selected a plan. Of those signups, 1,939,588 signed up through the federal exchange.
- Of the signups, 31% were under the age of 34, while 53% were between the ages of 45 and 64.
December enrollment official report
The official report for December enrollment was released January 13, 2014. Below are some notes from the report:
- Through the first three months of the six month enrollment period, 2,153,000 users had selected a plan. Of those signups, 1,196,000 signed up through the federal exchange.
- Of those who signed up, 30% were age 34 and under, while 55% were between the ages of 45 and 64.
November enrollment official report
The official report for November enrollment was released December 11, 2013. Below are some notes from the report:
- Through the first two months of the six month enrollment period, 364,682 users had selected a plan. Of those signups, 137,204 signed up through the federal exchange.
- The total applications filled out on state and federal exchanges totalled 1.8 million which represented 3.7 million individuals.
October enrollment official report
The first official report on Healthcare.gov enrollment was released November 13, 2013. According to a report by the Washington Post, the White House's definition of enrolled included not only those who have fully enrolled and paid a premium but also those who have an insurance plan selected in their online shopping cart. Generally, insurance companies only count people who have paid a premium in their official counts. The official report stated 106,185 people enrolled in plans through the state and federal exchanges. Below are more notes from the report.
- Through the first month of the six month enrollment period, 106,185 enrollees is 1.5% of the expected total by the end of the period. The enrollment figure included those who have "selected a plan by clicking a button on the website page" as well as those who have paid their premium.
- The total applications filled out on state and federal exchanges totalled 846,184 which represented 1,509,883 individuals. Another 259,107 applications were submitted by paper or call centers.
- Based on the history of similar programs (Federal Employees Health Benefits Program, Medicare Part D, Massachusetts' Commonwealth Care and the Children's Health Insurance Program), the report suggested enrollment spikes would follow "'action-forcing' events" such as the enrollment deadline and the start date for receiving benefits.
- The report stated 18,000 assisters have "informally" reached 450,000 consumers in the federal marketplace states.
- Washington, D.C., Hawaii and Oregon enrollment numbers were not available in the report.
Early enrollment estimates
- Citing an anonymous source close to the website, a Wall Street Journal report suggested the enrollment numbers for the federal exchanges through the first week of November were fewer than 50,000. An HHS spokesperson would not comment on the numbers, but suggested most enrollees would join later in the process.
- CBS News reported on October 31 that only six people enrolled in the system on October 1, 2013, the first day the exchanges opened. The "early day enrollment" figures were revealed in internal "war room" documents turned over in response to a subpoena from the House Oversight Committee.
- To meet the goal of 7 million enrollees by March 2013, the system requires an average of 39,000 enrollees each day.
- As of October 21, 2013, an NPR report estimated 129,000 people had enrolled between the federal and state exchanges, although the definition of "enrolled" by the state systems has been debated. "Enrolled" could refer to the number of people who have created accounts on the website but not yet signed up, or it could mean the number of people who have selected a plan. The definition in some states for the official numbers is someone who has paid their premium, but premiums aren't due until December 15. Meanwhile, also on October 21, senior Obama administration officials claimed 476,000 health insurance applications had been filed through the website.
FOIA request filed by media outlets
A number of media outlets, including CNN, ABC and MSNBC, filed Freedom of Information Act (FOIA) requests in October and November 2013. Among these requests, MSNBC asked for "up to date number of people who have enrolled in the government's healthcare exchanges set up by the [Affordable Care Act]," while ABC News requested "the documents detailing and describing the actual and potential costs associated with addressing flaws in [the HealthCare.gov] website from Oct. 1, 2013 to Oct. 21, 2013."
In recent weeks, President Obama had hinted that he was aware of enrollment, with speeches that allude to "thousands" having signed up since the launch of the website.
Type of enrollees
Ezra Klein of the Washington Post, wrote on November 26, 2013, that when asked what the measurement of success would be for enrollment on Healthcare.gov, the administration claimed the ratio for success would be having 39% of the signups be young, healthy people. If the number of young and healthy people did not reach that number, Klein suggested the premium costs for next year could be disastrous.
- A Gallup poll released December 2, 2013, showed that 37% of people under the age of 30 were unfamiliar with the ACA, while 26% between ages 30-49 shared the same unfamiliarity. Only 22% of the ages of 50-64 were not familiar. The success of the law depends highly on younger, healthier people enrolling.
According to a Washington Post report, no benchmarks were used during the development of the website. Contractor CGI Federal was not required to lay out performance benchmarks in their contract, a typical requirement for IT jobs. The administration did not set official goals until after launch, when they determined an internal goal of having the website be able to handle 80% of signups. The team of presidential innovation fellows assigned to help fix the site, noted that in order to meet the goal of 80% the error rate for the website would need to be under 1% and the average load time needed to be less than half a second per page.
- A month prior to Healthcare.gov going live, a test run was conducted on the parts of the website that were ready for testing. The problems found at that time led the test team to try to persuade the Centers for Medicare and Medicaid Services (CMS), the agency in charge of the website, to push back the October 1, 2013 launch date to have time to resolve the identified problems.
- Testifying before Congress on October 24, 2013, UnitedHealth Group's Andrew Slavitt and a CGI Federal senior vice president, Cheryl Campbell, stated they would have preferred months of testing instead of leaving only two weeks to test the entire system. CMS, not the contractors were responsible for testing, according to Campbell. Slavitt claimed, "We informed C.M.S. that more testing was necessary."
- A final test, days before launch, was conducted to test traffic volume. The objective of the volume test was to determine whether the website could handle "tens of thousands of consumers at the same time." During this test, the system crashed after a simulation that involved several hundred simultaneous users.
- According to a statement by White House press secretary Jay Carney on October 22, "We did not know until the problems manifested themselves after the launch that they would be as significant” as they were.
- Kathleen Sebelius said on October 22 that President Barack Obama was not aware of the scale of the problems prior to the October 1 launch.
Problems were known
According to a memo obtained by CBS News, in 2010 a top administration consultant, David Cutler, attempted to advise economic adviser Larry Summers of possible problems: "I do not believe the relevant members of the administration understand the president’s vision or have the capability to carry it out."
Independent pre-launch assessment
The private consulting firm, McKinsey & Co., assessed the progress of the website components in early 2013. The company noted the lack in sufficient time set aside for testing and revising, as well as the project not having one single leader and decision-maker. Some problems the McKinsey report covered were not problematic such as call center wait times and data hub liability. When asked about the report, a White House spokesman stated, "flags were definitely raised throughout the development of the Web site, as would be the case for any IT project this complex. . . . But nobody anticipated the size and scope of the problems we experienced once the site launched."
Issues with rollout
New accounts and logging in
In its first week, the website attracted as many as 250,000 users at a time. This exceeded administration estimates of 50-60,000 simultaneous users. The website produced error messages to most users trying to register. Once logged in, other error messages greeted users informing them that the system was down or that their accounts "couldn't be created at this time." The ability to chat with agents online timed out in a number of reported instances. The call center wait list was at 30 minutes or more.
U.S. Chief Technology Officer Todd Park said the high traffic to the website caused the site to get overloaded, and many predicted the issues in the software would be resolved within a few weeks. In the first week, only 1% of the estimated 3.7 million people who tried to register actually enrolled in a plan.
CNBC published a survey on October 17 conducted by uSamp, an online market research firm. This survey found that 20% of those surveyed were able to log onto HealthCare.gov without experiencing technical issues. 830 people were surveyed:
- 50 percent received a message asking them to "wait/try again later."
- 38 percent said they had "received an error message."
- 31 percent were "informed that the system was unavailable."
- 25 percent were "not able to create an account."
Data transfer problems
Once users enrolled in the process, Bloomberg reported insurance companies are receiving incorrect information from the Healthcare.gov exchanges. The information passed on to the insurance companies has often either been in inoperable files or missing vital information. Other issues had the exchanges sending multiple files for each enrollee, a mix of enrollments and cancellations and reporting spouses as children. Some companies have resorted to re-entering data by hand to correct the errors. The companies feared that if the website is fixed, allowing all users to enroll, the flood of bad data could lead to major problems.
Errors in price quotes
On October 20, 2013, the administration released the new "shop and browse" allowing consumers to look at pricing without having to fully login to the system. While they hoped this would ease the traffic on the actual exchange, CBS News discovered the new feature was often misquoting people on what plans may cost. Instead of using consumers' birthdays to get an accurate price quote, they only give the options of "Under 49" and "Over 50," meaning price quotes could be significantly different from the actual plan for a person's age. Insurance executives claim the quotes are misleading and useless.
In general, the Healthcare.gov website understates actual prices due to this system error. As an example of the error caused by this website feature, CBS found that Healthcare.gov estimates that a 48-year-old resident of North Carolina who is not subsidy-eligible would have to pay $231 a month for a "Silver" plan. However, the actual price should be $360 a month.
Insurers and the federal exchanges are missing the link that would allow consumers to enroll in an insurance plan directly through individual companies and still receive federal subsidies, according to an October 21, 2013 report in Politico. Insurers were supposed to be able to accept an individual's application and tap into the federal hub to determine their subsidy eligibility, easing the traffic to Healthcare.gov. The Department of Health and Human Services hoped to have the backdoor open by the end of the week.
On November 22, 2013, the CMS announced direct enrollment would begin to be rolled out in Ohio, Florida and Texas. A CMS spokeswoman acknowledged the option of direct enrollment has "been there from the start," but the site's problems were only recently fixed to the point that insurers could access premiums and tax credits for users.
Transfers from Medicaid
On November 1, the federal exchange must transfer Medicaid applications and beneficiaries to state agencies. Bobby Peterson, executive director of ABC for Health in Madison, Wisconsin, says this date will pose a test to the system: "If the marketplace isn’t working well by the first part of November, I think people are going to start raising major concerns."
Data hub outages
On Sunday, October 27, 2013, the data hub for Healthcare.gov as well as exchanges for 14 states and the District of Columbia, went down. The hub was operated by Verizon Communication Inc. and was down for about a day, blocking enrollment. Verizon and the Department of Health and Human Services declined to comment.
On Tuesday, October 29, 2013, the data hub experienced another outage. The outage was first noticed by the Connecticut state healthcare exchange, "Access Health CT," which like the other 14 state healthcare exchanges, needs data from the hub to function. The Connecticut exchange issued a statement that said, "Access Health CT was informed by CMS (Center for Medicare and Medicaid Services) that the Federal Data Services Hub is currently experiencing an outage." An official from the Department of Health and Social Services acknowledged the problem, writing, "Tonight, Verizon Terremark again experienced network issues in their data center that caused a system outage impacting the federal data services hub and the Healthcare.gov marketplace application."
Post-enrollment period data inconsistencies
The HHS inspector general released a report in June 2014 that from October to December 2013, 2.6 million data inconsistencies were not able to be resolved and pressured the Centers for Medicare and Medicaid to establish a public plan for resolving the inconsistencies. The healthcare exchange's data hub was designed to fact check applications against federal information from the Internal Revenue Service, Social Security Administration and U.S. Department of Homeland Security, but the initial tech issues with the data hub created the inconsistencies that possibly mislead customers about their eligibility to certain plans and tax credits. The inconsistencies that could not be resolved by the federal exchange dealt with citizenship status, income verification, and employee-sponsored minimum essential coverage. Eleven state marketplaces also reported inconsistencies during the rollout, but only four states have reported having unresolved problems. If the customer received a premium tax credit due to an inconsistency, the IRS would likely either seek benefits that were not supposed to be given or award tax credits to those who should have been eligible. The report stated, "If the applicant chooses the advance premium tax credit, the Internal Revenue Service (IRS) will reconcile the actual credit amount made on behalf of the individual when an individual files a tax return at the close of the year."
During Sebelius's House hearing on October 30, 2013, the website displayed a message stating:
- "The system is down at the moment. We are experiencing technical difficulties and hope to have them resolved soon. Please try again later."
Some debate ensued about whether "crash" is the right word to use when a website is not working; several members of Congress during the hearing did use the term as a synonym for "the website isn't working." Sebelius, however, advanced the perspective that the website has never "crashed." A spokesperson for the Health and Human Services Department separately backed Sebelius, claiming, "As the secretary says, the site works. But it is slow and has a lot of user errors. But even on the first day, some people could get all the way through the system. So it did not crash. If it crashed, it would have been totally down."
Highly-placed government IT officials from the Center for Medicare and Medicaid Services wrote a memo several days before the October 1, 2013 launch of Healthcare.gov warning about security risks. The memo said that the risk of security issues was "high."
Security flaws were said to pose a risk of compromising the privacy of social security numbers and birth dates.
The memo was made public because the House Oversight Committee requested it. According to the memo, "Due to system readiness issues, the SCA (security control assessment) was only partly completed...This constitutes a risk that must be accepted and mitigated to support the Marketplace Day 1 operations."
The White House, through its spokesperson Jay Carney, disputed that there was a risk. Carney said that "a process was put into place" to monitor security flaws. He also said, "In any website like this you have to constantly monitor and mitigate any security risks."
Manual back-up systems
On December 11, 2013, Sebelius acknowledged that a manual back-up system was in place temporarily to cover for software that had not yet been built and tested. The systems requiring manual back-ups are the verification process to see that those who sign up are actually enrolled with health insurance companies and a system for paying the subsidies to insurers. When asked about the back-ups, Sebelius stated, "There's a manual workaround for virtually everything that isn't fully automated yet."
State exchange enrollment problems
Fourteen states elected to create their own healthcare exchanges. As of November 12, 2013, signups had reached only 3% of their expected enrollment numbers in the 12 states that exchanges were "mostly working smoothly." Following is a list of some problems the individual state exchanges have faced.
- California: The Covered California exchanged hosted an event at the Sacramento Convention Center to manually enroll people in health insurance plans. Of the 1,500 people that showed up for the event, 10 applications were completed and 46 others were started by the 300 volunteers present.
- Connecticut: President Obama pointed out Connecticut's Access Health CT as a success attracting young, health individuals during his October 21, 2013, press conference, but the CT Mirror pointed out that many of the under-35 crowd that signed up would not count toward the private insurers' risk pools because they signed up for CHIP and Medicaid. The age group with the most signups counting toward the risk pools were those between 55 and 64.
- More than 2,400 Access Health CT users were given incorrect information about the insurance plans they signed up for. Each of the individual plans listed on the website had incorrect information about the deductibles and out-of-pocket costs. One man, John Javaruski got a letter notifying him his plan had gone from a $2,000 out-of-pocket maximum with $0 deductible to $6,250 out-of-pocket maximum with a $3,000 deductible.
- Hawaii: The Hawaii Health Connector exchange was not fully launched for consumer use until October 15, 2013, at which point some users experienced problems logging on to the site and accessing insurance options.
- Maryland: The executive director of Maryland's MarylandHealthConnection.gov, Rebecca Pearce, resigned December 6, 2013, with no explanation for stepping down. The exchange released a statement stating, "Ms. Pearce worked tirelessly and with tremendous dedication to build Maryland Health Connection over more than two years." The exchange struggled managing two contractors, Noridian Healthcare Solutions LLC and EngagePoint LLC which are now involved in a legal conflict in federal court. On March 10, 2014, Rep. Andy Harris called for a federal investigation by the U.S. Department of Health and Human Services into why the exchange had such a poor rollout. As of March 1, 2014, the state exchange had 38,070 signups.
- Massachusetts: The Boston Herald interviewed people trying to sign up on the Massachusetts Health Connector exchange who had serious concerns. Their concerns included being asked to answer questions about their incarceration after selecting that they had never been incarcerated, being stopped in the application process because of hyphenated names and confusion about deadlines and eligibility for part-time workers and the self-employed.
- Minnesota: While the MNsure exchange posted a chart showing the income ranges eligible for tax credits, many consumers in those ranges were not eligible to receive the credits because it was deemed certain health plans were low enough in cost to fit with their income. A spokesperson explained the situation, "So while they technically would be eligible for a tax credit, they fall into that income range. It's just that the premiums are so low, that they meet the affordability threshold."
- Oregon: The Oregon exchange, Cover Oregon, was not completed as of November 10, 2013, with no specific timeline for when it might launch. A communications officer for Cover Oregon stated, "We stuck to the vision, and we're experiencing now the bumps that go along with having a grand vision that doesn't work out exactly the way you hope it will." The executive director of Cover Oregon resigned in January 2014.
- Vermont: Governor Peter Shumlin announced on October 31, 2013, that existing coverage, which was to expire on December 31, 2013, would be pushed back to expire on March 31, 2013, due to website problems.
- Washington: About 8,000 Washington residents received letters notifying them that those who enrolled through the Washington Health Benefits Exchange were given an incorrect estimate. The exchange used the federal data hub to calculate tax credits but submitted monthly income to the hub, instead of the annual income they used to calculate the credits. The result was early enrollees were told they would receive higher tax credits than they were eligible for.
- Washington, D.C.: In the first month after the site's launch, five Washington, D.C. residents successfully enrolled in the DC HealthLink exchange. The report showed more have completed applications for health insurance, but they have not yet paid their premiums to be counted as enrolled. The exchange information was obtained by Sens. Chuck Grassley, (R-IA) and Orrin Hatch, (R-UT).
Why did problems happen?
A number of theories have been put forward to explain the observed problems with Healthcare.gov.
The "health care exchange was built using 10-year-old technology," according to technology experts quoted in an October 17 article in USA Today. John Engates, the chief technology officer at Rackspace, said, "It is a core problem in the sense of it's fundamental to this thing actually working, but it's not necessarily a problem that the people who wrote HealthCare.gov can get to. Even if they had a perfect system, it still won't work.
CSM level of expertise
The Centers for Medicare and Medicaid Services (CMS) were in charge of piecing together databases from 55 different contractors, but people involved in the project did not believe the agency had the overall technological and managerial capability to execute a project of the needed complexity, according to the New York Times.
Lines of code
Slate writer Will Oremus suggested that the 500 million lines of code used to create the website was far too many, and any project that size was doomed to fail. As a comparison, the Windows Vista operating system contained 50 million lines and users complained about the system being too slow.
David Auerbach, also of Slate, disputed the validity of claims made by fellow writer Will Oremus as well as the New York Times. He stated that the lack of detail given by the New York Times source about the amount and type of code and the source placing blame on the CMS's management of the project, could mean the anonymous source was a management-type working for contractor CGI Federal trying to shift blame for the struggling website.
Dave Kennedy, CEO of Trusted Sec, compared the 500 million lines of code to the Windows 8 operating system, which has about 80 million lines of code. Online banking system usually have between 75 million and 100 million lines of code. Kennedy said he thought that Healthcare.gov should have in the range of 25 million to 50 million lines of code. He adds, "The [500 million lines of code] says right off the bat that something is egregiously wrong. I jumped back when I read that figure. It's just so excessive."
Size of project
ComputerWorld, on October 21, reported on a study of websites costing over $10 million, showing that of 3,555 projects in the public and private sector, only 6.4% were successful. Over 50% of those projects suffered problems, such as going over budget, past deadlines or lack of user satisfaction.
Kevin Drum of Mother Jones opined a large part of the problem came from having a release date that was not able to be moved in case of problems. Drum wrote, "They had to ship on October 1. Period. And so now I find myself thinking back to some of those difficult projects. What would have happened if instead of slipping the schedule, I had been forced to ship on the original release date? Answer: the software flatly wouldn't have worked. It wouldn't just have been bad, it would have been an existential catastrophe. And it would have taken many months to fix, not many weeks."
Last-minute design changes
Gail Wilensky, a health analyst who is a former director of Medicare and Medicaid, said that the federal government gave contractor CGI a number of last-minute design changes and that this hampered their ability to deliver a working website on deadline.
Arron Kallenberg, a software engineer, said, "Projects that are done rapidly usually have a lot of [repetitive] code. So when you have a problem, instead of debugging something in a single location, you're tracking it down all through the code base."
Lack of funds
Don Berwick, a former chief of Medicare and Medicaid for the Obama administration, said that funding for the website was not available when it would have mattered: "The total implementation budget for Obamacare in the first two years, as I recall, was something in the order of $1 billion. The resources were spread quite thin and it was not possible at that time to get more resources from Congress. We really wished there were more. The money wasn’t there."
When the ACA passed into law, the Obama administration needed to decide who would implement the reform. National Economic Council Director Larry Summers and Office of Budget and Management Director Peter Orszag agreed with the health adviser for Obama's 2008 campaign, David Cutler, that nobody in the administration would be capable of completing the task. Summers, Orszag and Obama healthcare adviser Zeke Emanuel pushed for the administration to bring someone on with experience in business, insurance and technology. However, other top health aides in the administration wanted to see the bill they worked so hard to pass, through to fruition. President Obama chose his own policy team to run the project under direction of the director of the White House Office of Health Reform, Nancy-Ann Deparle. Cutler stated, "They were running the biggest start-up in the world, and they didn't have anyone who had run a start-up, or even run a business. It's very hard to think of a situation where the people best at getting legislation passed are best at implementing it. They are a different set of skills."
The building of Healthcare.gov was challenged due to the constant threat of Republicans trying to defund any aspect of the law they could. Paired with the fact that money was only specifically set aside for the state exchanges to be created, the federal exchange was peicemealed together by staff throughout the CMS office locations. According to a former administration official, "There wasn't a person who said, 'My job is the seamless implementation of the Affordable Care Act.'"
High-level meeting attendance
Starting after the law's passage, monthly meetings were held including Kathleen Sebelius, Treasury Secretary Timothy Geithner, Chief of Staff Rahm Emanuel and Domestic Policy Council Director Melody Barnes. The group worked through regulatory issues dealing with the implementation of the law, but before the year was out, the meetings stopped due to declining attendance.
Many states, under pressure from Republicans, opted not to build state exchanges and instead depend on the federal exchanges. While each new state on the federal exchanges added complexity, the administration would not admit to the additional technical issues posed. Instead, they decided to wait for the 2012 elections, hoping more states would opt to create their own exchanges. This meant the contractors, particularly CGI Federal, were not given specifications until after the elections, holding up technical work on the website.
The election also impacted important regulations of the law. The standards for insurance coverage and rules for insurance premiums were made official as late as February 2013. A former Medicare chief actuary suggested the aides who pushed the law through Congress risked poor implementation "for a short-term political gain."
Efforts to fix
The Obama administration on October 20, 2013 announced changes they hoped would solve some of the issues faced by those attempting to use the website.
Proposed fixes included:
- Adding new code to fix bugs. Contractors believed up to five million lines of code would need to be revamped in order for a major fix to happen, but many were not confident it could be done even by December 15, the deadline for users to enroll in a healthcare plan effective starting in January 2014.
- The Department of Health and Human Services also announced they would be bringing in some of the "best and brightest" from government as well as the private sector in order to roll out a major update.
- On October 23, the administration named Jeffrey Zients to lead the "tech surge" on the Healthcare.gov site.
Change the sign-up deadline
The White House announced late on Wednesday, October 23 that because of the problems with the website, they were going to redefine the meaning of the March 31, 2014 deadline. Originally, people were required to have a paid policy in place by March 31. The White House, however, said they are going to redefine March 31 as the date by which an individual must have started the enrollment process, rather than the date by which the enrollment must have been successfully concluded.
Estimated time to fix
- During Health and Human Services Secretary Kathleen Sebelius' House hearing on October 30, 2013, she estimated the completion date for fixes to be November 30, 2013. According to a statement released by the Health and Human Services Department, as of November 26, 2013, 90% of Healthcare.gov users are able to create accounts. The site was down for maintenance from November 29 at 9 p.m. Eastern time until November 30 at 8 a.m. Eastern time in order to complete the site upgrades by the November 30 deadline. Jeffrey Zients claimed, "HealthCare.gov, on Dec. 1, is night and day from where it was on Oct. 1."
- Some officials in the healthcare industry said that a fix to the website may be on a timeline of months, not weeks.
- Mark Bertolini, the CEO of Aetna Insurance, told CNBC two weeks into the October launch that he thought it might take three years to repair the website.
- Dave Kennedy, CEO of information security company Trusted Sec, said that if 20% of 500 million lines of code need to be rewritten, this will take six months to a year.
Tech surge to fix
On October 30, 2013, CMS officials claimed the "tech surge" to repair Healthcare.gov included "dozens" of people from the private and public sectors.
Head of surge
On October 23, 2013, the Obama administration announced Jeffrey Zients would lead the "tech surge" to fix Healthcare.gov. Zients has led private companies like Sirius/XM Satellite Radio, Bain & Company management consulting and Revolution Health, as well as holding public offices in the Office of Management and Budget and leading a trade and export reform for the Obama administration in 2011.
Soon after taking the post, Zients stated, "We're confident by the end of November, HealthCare.gov will be smooth for a vast majority of users." CMS Communications Director Julie Bataille backed up Zients' comment claiming, "People will be able to apply by Dec. 15 to get coverage by Jan. 1." Zients' assessment of the site concluded the top priority was to address the problems insurance companies have received from the exchanges.
The "tech surge" drew help from top tech companies such as Google Inc., Red Hat, Inc. and Oracle Corp. among others. Each of the individuals and companies participating had connections to the Obama administration in the past. The administration did not release the full list of participants in the "tech surge."
- Google engineer Michael Dickerson left Google on leave to help on the project. Dickerson conducted analytics for the Obama for America campaign, and he will be working with contractor Quality Software Services Inc.
- Greg Gershman is a Presidential Innovation Fellow for the White House placing innovative candidates on government projects. He was assigned to work with CGI Federal.
- Oracle Corp. produced an identity verification tool for the project early in development. Oracle has done contract work with the government in the past.
- Red Hat, Inc. also has a history of contracting with the government, specifically on IT projects. They would not comment on their role in the surge.
- Other companies may not wish to be publicly associated with such a politically charged project.
Website daily down time
A banner on HealthCare.gov has been alerting users of a daily down time from 1 a.m. to 5 a.m. EST. The banner states: "Additional down times may be possible as we work to make things better."
Following the initial "tech surge" ending November 30, 2013, new fixes were introduced to the system.
- By midday the first day the fixes were introduced, the website experienced traffic of about 380,000 visitors. While the site did not crash, a new waiting room feature was introduced in order to limit the number of people on the site at the same time for optimal performance. The site can reportedly handle 50,000 users simultaneously.
- Zients claimed at the start of November the website was only up about 43% of the time, while after the November 30 deadline the "up time" was 95%.
- Director of Office Communications for the CMS Julie Bataille stated that the success rate for sign-ups was up to 80% from the 30% success rate at the end of October.
The penalty for not being enrolled in a health insurance plan by March 31, 2014, is a charge of either $95 per person or 1% of household income, whichever is greater. White House Press Secretary Jay Carney would not say on October 21, 2013 whether the struggles of the website could delay the individual mandate. The administration announced in March 2014, that uninsured users could still enroll April, paying their first premium, to avoid the penalty as long as a plan was selected by March 31, 2014.
GAO investigation results
The Government Accountability Office (GAO) investigated the costs of the Healthcare.gov federal exchange website, estimating that the total cost, as of March 2014, was $840 million. GAO Director of Acquisition and Sourcing Management William Woods claimed that the overrun was due to inconsistent oversight and constantly changing requirements, which were noted by contractors when asked to testify during the website rollout.
- According to Kathleen Sebelius' House testimony on October 30, 2013, the website had a cost of $118 million plus another $56 million for IT support.
- As of October 17, 2013, Fiscal Times estimated the CGI Federal contract for the website had a cost of $292 million, after agreeing to an initial contract of $93.7 million in 2010.
- Digital Trends estimated the total cost of the website to be $363 million, but due to the shutdown, they could not access CMS salary information and did not include it.
- The Sunlight Foundation claimed that due to the nature of government contracts called "IDIQs" (indefinite delivery, indefinite quantity), the official cost for the Healthcare.gov website is difficult to know. The contract allowed the government to contract tasks to the holder of the contract, CGI Federal, without opening them to competition. Their analysis listed 128 action items for a total of $634,321,919; however, not all tasks were necessarily related to the website.
According to the Sunlight Foundation, the ten highest paying initial federal contracts for the website are listed below:
|Highest earning federal contractors for the ACA|
|Quality Software Services, Inc.||$68,339,812|
|Maximus Federal Services, Inc.||$43,163,074|
|McKinsey and Company||$13,767,707|
|Porter Novelli Public Strategies||$11,670,603|
- Note: This list does not include the contracts used for state exchanges, including a total of $140 million to Xerox Co. for the exchanges built for Florida and Nevada.
Quality Software Services, Inc.
QSSI was contracted to develop a component focused on identity management, a key part of the login process that experienced problems during rollout, and QSSI was chosen by the administration as the contractor to lead the "tech surge" aimed at fixing the website's problems. The New York Post estimated QSSI had been paid $150 million as of November 1, 2013, but acknowledged more may be on the way for the website fixes.
Connections to the administration
The company was bought in 2012 by UnitedHealth Group, one of the largest health insurance companies in the U.S. In addition to lobbying efforts for Obamacare, Executive Vice President Anthony Welters and his wife were campaign contributors to Barack Obama's 2008 and 2012 campaigns. Welters' wife, Beatrice was appointed to be U.S. ambassador to Trinidad and Tobago in 2009, and the couple have visited President Obama in the White House multiple times.
CGI Group, the parent company of Healthcare.gov contractor CGI Federal, was the 29th largest federal IT contractor in 2012, totalling about $950 million in contracts, but that number has grown as they worked on the healthcare website. CEO Michael Roach claimed, "In the Federal Government business, we continue to see more extensions and ceiling increases on our existing work, while we further leverage our position on contract vehicles," continuing to state, "Accordingly, we continue to view U.S. Federal Government as a significant growth opportunity." CGI Federal was given six contracts by CMS for Healthcare.gov to build the shopping and enrollment aspects. They reportedly missed multiple deadlines, though those close to the project claim officials had not finalized parts of the ACA necessary to move forward with the contracted work.
Of the 55 contractors who have worked on Healthcare.gov, CGI had the largest role. It was awarded its contract in October 2011 for a bid of $94 million. By May 2013, CGI increased its contractual cost ceiling to $292 million.
According to a report on November 23, 2013, CGI held meetings with the administration to gauge confidence in completing their projects in August 2013. CGI Federal reported high confidence rates in their ability to complete the tasks, but on a "pre-flight checklist," 41 of 91 items critical to a successful launch did not yet work.
Past government contracts
- 2012: The company was fired by an Ontario, Canada provincial health agency for missing deadlines and failing to provide the online medical registry the company was contracted to create.
- 2009: CGI Federal transformed an existing Environmental Protection Agency program into FederalReporting.gov, deemed a successful and inexpensive project that was completed on time.
- 2007: The company was also fired by the Canadian government in 2007 after going over budget creating a federal online gun registry.
- 2007: CGI Federal won one of 16 IDIQ contracts for $4 billion to upgrade the Medicare and Medicaid systems.
Connections to the administration
CGI Federal Senior Vice President Toni Townes-Whitley was a college classmate of First Lady Michelle Obama and attended a Christmas party at the White House. Both she and George Schindler, president of CGI Federal, donated to the Barack Obama's campaigns.
Serco was contracted by the government to process the paper applications for health insurance plans through federal exchanges. The contract was the largest awarded as part of the implementation of the ACA and was valued at a potential of $1.249 billion over the full term.
- 2013: England's Serious Fraud Office began investigating Serco for a overbilling on a contract to surveil criminals released from prison. An audit revealed Serco overbilled the government for about $80 million. The CEO resigned on October 25, 2013.
- 2013: A Serco lobbyist and former Capitol Hill staffer, Mark Hayes, went under investigation for insider trading concerning aspects of the ACA. As of May 2013, he was expected to stop lobbying for Serco.
- 2013: Women at the Yarl's Wood immigration detention center, contracted to Serco by the British government, claimed officers bribed them with better service to engage in sexual behaviors. In 2012, at least three staff members were fired due to accusations of sexual assault.
- 2011: The Serco-managed U.S. Thrift Savings Plan for federal employees experienced a security failure resulting in private information, including social security numbers, being jeopardized for 120,000 plan participants.
- 2011: Serco teamed with King's College Hospital and Guy's & St. Thomas Hospital to win a $1.29 billion contract running a National Health Service pathology lab in 2009. Hundreds of errors were discovered in 2011 including mislabeled or lost blood and tissue samples and inaccurate testing results.
- 2011: The Australian government uncovered "over-crowding" and "ill-trained" staff at immigrant detention centers. The company also failed to produce regular reports required by their contract, and incidents of self-harm increased in the facilities while Serco was in charge.
- 2006: Serco was awarded a contract in England to run an out-of-hours physician service for the country. It was discovered the program's services declined to the point that at times only one physician was on call for the entire country. The Care Quality Commission released a statement saying Serco "routinely altered daily performance reports which showed if the service was meeting its targets for responding to calls from patients on time."
Contracting practices investigation
On December 11, 2013, Sebelius asked the inspector general of the Health and Human Services Department to open an investigation into the contracting practices involved in the Healthcare.gov website. She said the investigation's results would help to prevent future issues like happened with the website rollout. She also announced the creation of a chief risk officer position in the Centers for Medicare and Medicaid Services.
New contractor search
In April 2014, the Obama administration began a search for new contractors to run to Healthcare.gov, with target contractors being small businesses run by women, disabled veterans and "socially and economically disadvantaged individuals."
- According to a CBS survey conducted October 18-21, 2013, only 12% of Americans believed the sign-up process on Healthcare.gov was going well, while 49% believed it was not going well and 38% didn't know enough. While the survey showed the rollout is not going well, opinions on the law remain consistent with when the rollout began October 1. Americans' disapproval of the law stands at 51% while 43% approve of it.
UnitedHealth Group's Andrew Slavitt and a CGI Federal senior vice president, Cheryl Campbell, testified before the United States House Energy and Commerce Committee on October 24, 2013. Following are some issues that came up during their testimony:
- The website was not fully tested by federal officials until two weeks prior to launch. Both Slavitt and Campbell stated months of testing should have been carried out per industry standards.
- The contractors blamed CMS for the website's troubled rollout due to their roll as "systems integrator." When Republicans requested who was responsible at CMS, the only two names to come up were Deputy CIO Henry Chao and COO Michelle Snyder, whom Campbell claimed to have reported to throughout the project. Campbell also stated, "It was not our decision to go live. It was [CMS’s] decision."
- House Republicans attacked the website as a symbol of the failure of the Affordable Care Act. Rep. Fred Upton claimed, "This is more than a Web site problem. The Web site should have been the easy part. I'm also concerned about what happens next. Will enrollment glitches become provider payment glitches? Will patients show up at their doctor's office or hospital only to be told that they aren't covered, or even in the system?"
- Slavitt suggested that a late change to the system by the administration contributed to the backup upon the site's initial release. Instead of allowing users to browse the website for plans without an account, the administration insisted users create an account and log in before viewing their options.
Marilyn Tavenner hearing
Marilyn Tavenner, the head of the Centers of Medicare and Medicaid Services, testified before the House Ways and Means Committee on October 29, 2013. The CMS was responsible for Healthcare.gov's creation. Following are some issues that came up during her testimony:
- On the website, Tavenner stated, "I want to apologize to you that the website does not work as well as it should," but claimed resolutions were in progress and the site should be running smoothly by the end of November. She did say the website was working, "just not working at the speed that we want and at the success rate that we want."
- On the contractors hired for the project, Tavenner claimed they "have not met expectations."
- Due to increased requirements under the ACA, Tavenner suggested some people will be forced to change their existing plans to plans that meet the new minimum requirements.
- Tavenner claimed accurate enrollment numbers would not be available until the mid-November report was produced.
Kathleen Sebelius hearing
Secretary of Health and Human Services Kathleen Sebelius testified before the Energy and Commerce Committee about the Healthcare.gov website rollout. Following are issues that came up during her testimony:
- According to Sebelius, the website had cost $118 million plus another $56 million for IT support.
- Sebelius supported Jeffrey Zients' estimation that the website will be fully functional and fixed by November 30, 2013.
- Reps. Mike Rogers, (R-MI) and G.K. Butterfield, (D-NC) brought up potential security issues due to the inadequate testing performed on the website before rollout. Sebelius insisted the suggested recommendations were being followed for security, including daily tests, monitoring the site's security and a thorough test of the complete website within three months. Sebelius also acknowledged more testing was not possible due to time shortages leading up to the launch date.
- Sebelius confirmed that the contracts for the construction of the website did not include "built-in penalties" for faulty work, but claimed the Department would not honor the contracts if work was left incomplete.
- Sebelius refused to release any numbers indicating the amount of people enrolled through the website until the first report was released in mid-November.
- When asked whether Sebelius would join the healthcare exchange if she could by law, after some back and forth with Rep. Billy Long, (R-MO) Sebelius stated, "I think it's illegal for me to access the marketplace. I would gladly join the exchange if I didn't have affordable coverage in my workplace. I would gladly join it."
IT specialist hearing
On November 13, 2013, major IT specialists who worked on the project testified before House Oversight Committee. The six witness included Chief Technology Officer Todd Park, CMS Deputy Chief of Information Henry Chao and Office of Management and Budget Chief Information Officer Steve VanRoekel. Following are some of the topics raised at the hearing.
- When asked of the improvements being made to the website, Park stated, "The website is getting better each week as we work to improve its performance, its stability, and its functionality."
- Rep. Darrell Issa, (R-CA) accused the White House of forcing the website on Americans before it was ready because of "political deadlines, and continued to state, "They weren't ready. They weren't close to ready. This wasn't a small mistake. ... This was a monumental mistake to go live and effectively explode on the launch pad."
- David Powner, a Government Accountability Office official offering testimony, claimed the total cost of the website as over $600 million by the end of September. However, according to the Washington Post, the number he gave was an outdated overestimation, and that the updated version of the form Powner referred to claimed the site had cost $318 million.
On April 10, 2014, Secretary of Health and Human Services Kathleen Sebelius resigned from her position following the troubled rollout of Obamacare. She and President Obama determined that the end of the open enrollment period provided a chance for change. Sebelius saw her public appearances dwindle as the problems with the Healthcare.gov rollout persisted. President Obama named Director of the Office of Management and Budget Sylvia Mathews Burwell as the nominee to succeed Sebelius.
Miscalculated eligibility frustrations
- Jessica Sanford, a Washington state resident President Obama mentioned during his October press conference on Healthcare.gov, initially wrote a letter to the president upon enrolling in an insurance plan in October, telling him what a financial relief the ACA was on her family. She chose a "gold" plan that, with subsidies, cost $198 per month. Sanford then received a letter informing her that there was a miscalculation in her tax credit eligibility, raising the cost of the plan to $280 per month. After that, she received another letter from the state exchange stating there was another error resulting in applicants qualifying for higher than allowed tax credits, resulting in quotes of $390 for a "silver" plan or $324 for a "bronze" plan, each with higher deductibles. A final letter came telling Sanford she did not qualify for any federal tax credits. Sanford responded, stating "This is it. I'm not getting insurance. That's where it stands right now unless they fix it."
Popular media blowback
While early support from various stars was common, as the struggles with Obamacare have continued, satire grew more popular with television shows such as The Daily Show, South Park and Saturday Night Live airing segments highly critical of the website and administration. Celebrity supporters and media outlets such as Funny Or Die still have long-term efforts in mind but have largely remained quiet during the troublesome rollout.
Barack Obama's grassroots organizers for the Obamacare rollout were some of the hardest hit by the problematic rollout of Healthcare.gov. The volunteers and coordinators filled out forms and knocked on doors to enroll people in insurance plans with the website not allowing many users to enroll. Their planning for the October 1 launch date of the new federal exchanges went from excited and carefully laid out to frustration and creating new plans on the go. Niki King, vice president of Access to Healthcare Network in Nevada, one of the many non-profits aimed at walking consumers through the new process, has been struggling with using excel sheets to calculate costs and said, "It's a mess. I'm fascinated to know how Obama says you can complete enrollment by paper." While frustrations were common, organizers insisted they would not stop helping the underserved get health insurance.
Direct enrollment letters
Eight Senate Democrats signed a letter in the end of November 2013, urging the administration to allow internet health insurance brokers to complete enrollment for all aspects of Obamacare without forcing consumers to use Healthcare.gov, stating, "We believe it is appropriate for consumers to have multiple enrollment channels in order to maximize choice and make enrollment as convenient as possible." The Senators believed the letter was necessary because many of their constituents had difficulty signing up for health insurance coverage on the official website. The eight Senators to sign the letter were:
Investigation into Healthcare.gov rollout failure
Sen. Kay Hagan, (D-NC) passed around a letter seeking signatures in November 2013, to order an investigation on the rollout of Healthcare.gov including initial expected costs, final cost estimates, contract sizes, contract performances and the contract bidding process. The letter was expected to receive signatures from both parties. A portion of the letter reads, "These problems are simply unacceptable, and Americans deserve answers and swift solutions. Taxpayers are owed a full and transparent accounting of how the vendors contracted to build the site failed to launch it successfully."
Individual mandate extension letter
On October 25, 2013, 10 Democratic Senators signed on to a letter written by Sen. Jeanne Shaheen, (D-NH). The letter urged President Obama to push back the deadline for the individual health insurance mandate due to the issues with the Healthcare.gov website. The letter did not suggest how long the mandate should be delayed, though one signer, Sen. Kay Hagan, (D-NC), separately called for a two month delay. A portion of the letter stated, "Extending this period will give consumers critical time in which to become familiar with the website and choose a plan that is best for them. Individuals should not be penalized for lack of coverage if they are unable to purchase health insurance due to technical problems."
The signers of the letter were:
Letter for Sebelius' resignation
On October 24, 2013, 32 House Republicans signed a letter to President Obama calling for the resignation of Secretary of Health and Human Services Kathleen Sebelius. Text of the letter included, "The scope of the problem is so great that, were this a private company or military command, the CEO or general would have been fired. We are, therefore, calling on you to hold Secretary Sebelius accountable for the fiasco that is HealthCare.gov and ask for her resignation."
Those who signed the letter include:
- David Schweikert, (R-AZ)
- Jim Jordan, (R-OH)
- Bill Shuster, (R-PA)
- Jeff Duncan, (R-SC)
- Mike Pompeo, (R-KS)
- Tim Huelskamp, (R-KS)
- Kerry Bentivolio, (R-MI)
- Steve Daines, (R-MT)
- Ron DeSantis, (R-FL)
- Jim Bridenstine, (R-OK)
- Randy Weber, (R-TX)
- Ted Yoho, (R-FL)
- Larry Bucshon, (R-IN)
- Andy Harris, (R-MD)
- Alan Nunnelee, (R-MS)
- Walter Jones, (R-SC)
- Louie Gohmert, (R-TX)
- Trent Franks, (R-AZ)
- Paul Broun, (R-GA)
- Blaine Luetkemeyer, (R-MO)
- Steve Southerland, (R-FL)
- Mo Brooks, (R-AL)
- Roger Williams, (R-TX)
- Vicky Hartzler, (R-MO)
- Michele Bachmann, (R-MN)
- Stephen Fincher, (R-TN)
- Bob Gibbs, (R-OH)
- Jim Renacci, (R-OH)
- Pete Olson, (R-TX)
- Phil Gingrey, (R-GA)
- Steve Stockman, (R-TX)
- Doug LaMalfa, (R-CA)
International government-run healthcare IT comparisons
- In 2002, the British National Health Service(NHS) began a program aimed at improving the use of technology in healthcare by digitizing medical records and unifying healthcare IT under one system for hospitals nationwide. The program was stopped in 2013 and named by a Public Accounts Committee report as one of the "worst and most expensive contracting fiascos" in British government history. The total amount spent on the project was estimated to have been over 9.8 billion British pounds due to technical problems and contractual problems.
- The Ontario provincial government attempted to create an online registry for people suffering from diabetes in 2010. They contracted CGI Group, Inc. for a $46 million, 6-year deal, but the company was fired in 2012 after missing multiple deadlines, including creating the registry itself.
Alternatives to Healthcare.gov for insurance
The alternative ways to become compliant with the ACA without using the Healthcare.gov website include:
- State-run exchanges
- Paper applications
- Telephone hotline
- In-person navigators
- State Medicaid offices (if qualified)
- Directly through health insurance companies
- Other online brokers and aggregators
- In-person insurance brokers
Three programmers living in California were frustrated with their struggles using the federal exchange and created a semi-alternative to Healthcare.gov using available public data. Consumers could insert their age, location and family and income details to preview what plans would be available to them. Users can't purchase plans on the site, but Health Sherpa attracted over 200,000 unique viewers in less than a week. The site reported cost a few hundred dollars to create. Co-creator George George Kalogeropoulos stated the reasoning behind their idea being, "We were surprised to see that it was actually fairly difficult to use HealthCare.gov to find and understand our options. Given that the data was publicly available, we thought that it made a lot of sense to take the data that was on there and just make it easy to search through and view available plans."
- November 26, 2013: On the administration's self-imposed goal of having the website optimized by November 30, "We are seeing more and more enrollments each and every day. A very different kind of user issues. We've added hardware. We've added software. We're continuing to work on the parts of the website that were too confusing to people and well beyond December 1, those improvements will continue. We get feedback on a regular basis from user experiences. We want to continue to update this."
- October 30, 2013: During testimony in front of the House Energy and Commerce Committee, Sebelius stated: "In these early weeks, access to HealthCare.gov has been a miserably frustrating experience for way too many Americans, including many who have waited years, in some cases their entire lives, for the security of health insurance."
- October 22, 2013: When asked if she had spoken with President Obama about resigning: "What I talked about is doing the job that I came here to do. … I think my job is to get this fully implemented and to get the website working right. And that’s what I’m focused on."
- October 10, 2013: At a promotional event for Healthcare.gov in Pittsburgh, Sebelius stated: "Believe me, we had some early glitches, but it's getting better every day."
- April 12, 2013: On whether or not the Health and Human Services Department needed a backup plan for potential delays: "No. We are determined and on track to meet the Oct. 1 deadline."
- November 25, 2013: "I think it's fair to say I’m not happy about the fact that we didn't have a Web site that worked on the day it was supposed to work -- although it's actually starting to work pretty well now, and it's going to be working even better in the coming weeks."
- October 21, 2013: On opponents of the law rooting for the healthcare law's failure: "That product is working. It's really good. And it turns out there's a massive demand for it." He continued, "But we did not wage this long and contentious battle just around a website. That’s not what this was about."
- October 15, 2013: On the struggles of the website: "The website that was supposed to do this all in a seamless way has had way more glitches than I think are acceptable."
- October 1, 2013: On the problems encountered on the initial release of Healthcare.gov: "Consider that just a couple of weeks ago, Apple rolled out a new mobile operating system, and within days, they found a glitch, so they fixed it. I don't remember anybody suggesting Apple should stop selling iPhones or iPads or threatening to shut down the company if they didn't. That's not how we do things in America. We don't actively root for failure. We get to work, we make things happen, we make them better, we keep going."
- October 15, 2013: On calls for Secretary of Health and Human Services Kathleen Sebelius's resignation: "The secretary does have the full confidence of the president. She, like everyone else in this effort, is focused on our No. 1 priority, which is making the implementation of the Affordable Care Act work well. People are working 24/7 to address the problems and isolate them and fix them, when it comes to the website and enrollment issues."
- Robert Gibbs
- October 14, 2013: Former Press Secretary for President Obama, Robert Gibbs, stated about the website's problems: "I hope they're working day and night to get this done. And when they get it fixed, I hope they fire some people that were in charge of making sure that this thing was supposed to work."
- October 6, 2013: On the problems during the website's launch: "It is not unique that when you have a very large, new software program come out that people work to clean it up."
- Rep. Fred Upton, (R-MI)
- October 24, 2013: During a congressional hearing with the Healthcare.gov contractors: "This is more than a Web site problem. The Web site should have been the easy part. I'm also concerned about what happens next. Will enrollment glitches become provider payment glitches? Will patients show up at their doctor's office or hospital only to be told that they aren't covered, or even in the system?"
- October 17, 2013: On Sebelius not clearing time on her schedule to testify before the House Energy and Commerce committee: "The rollout has been a complete mess, beyond the worst case scenario, and yet those administration officials responsible have indicated they will not be available to testify next week. This is wholly unacceptable. Secretary Sebelius had time for Jon Stewart, and we expect her to have time for Congress."
- October 10, 2013: On the website's unsteady rollout: "Despite the widespread belief that the administration was not ready for the health law’s Oct. 1 launch, top officials and lead IT contractors looked us in the eye and assured us all systems were a go. Instead, here we are 10 days later, and delays and technical failures have reached epidemic proportions."
- Sen. Ted Cruz, (R-TX)
- October 21, 2013: On the troubled website rollout: "You may have noticed that all the Nigerian email scammers have become a lot less active lately. They all have been hired to run the Obamacare website."
- Rep. John Fleming, (R-KS)
- October 14, 2013: On Sen. Roberts' call for Secretary Sebelius' resignation: "The rollout of Obamacare, like the law itself, has been a mess. For the sake of the American health care system, as well as jobs and the economy, Obamacare should be repealed. In the meantime, someone must be held accountable for wasting taxpayer dollars on a rollout that was more than three years in the making."
- Sen. Pat Roberts, (R-KS)
- October 11, 2013: Sen. Roberts issued a YouTube video calling for Sebelius to resign, stating: "Enough is enough. Today I am calling on Kathleen Sebelius to resign her post as Secretary of Health and Human Services. Secretary Sebelius has had three and a half years to launch Obamacare, and she has failed."
- Rep. John Boehner, (R-OH)
- October 10, 2013: On the administration not adjusting the individual mandate deadline: "How can we tax people for not buying a product from a website that doesn’t work?"
- Rep. Darrell Issa, (R-CA)
- October 9, 2013: On the Healthcare.gov rollout problems: "Basically, HHS has screwed this whole thing up."
- Sen. Jay Rockefeller, (D-WV)
- October 21, 2013: On the implementation of the healthcare law: "I firmly believe these technical glitches will get worked out so people can more easily sign up for health insurance. Transforming an entire health care system, especially one as enormous and fractious as ours, doesn't happen overnight."
- Rep. Nancy Pelosi, (D-CA)
- October 21, 2013: On the initial problems with the website: "They were overwhelmed to begin with. There is much that needs to be done to correct the situation."
- Sen. Max Baucus, (D-MT)
- October 16, 2013: On the website's troubles: "Any major undertaking will have a few glitches. They’re working them out. In the end it’s going to work fine. I have a lot of confidence — because of the people I’ve been talking with inside government and outside government, both public and private sector."
- Rep. Sandy Levin, (D-MI)
- October 16, 2013: On the website's early issues: "Clearly, there are problems that need to be fixed and they’re under way but it has to be accelerated."
- Sen. Ed Markey, (D-MA)
- October 10, 2013: On the website rollout problems and the shutdown: "[It’s] pretty clear that they’re working on the glitches in Obamacare, and it’s pretty clear that we need a geek squad for the website, not a firing squad for the entire bill."
- Rep. Rob Andrews, (D-NJ)
- October 8, 2013: On speaking with the White House in Summer 2013 about potential flaws in the system: "Nothing I told them ever surprised them. The White House has acknowledged all along something this massive was going to have implementation problems."
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- Obamacare overview
- Health insurance policy cancellations since Obamacare
- United States budget debate, 2013
- United States involvement in Syria
- Obama administration past and current views on Syria
- NBC News, "Better use the phone: Why Obamacare website is such a fail," October 21, 2013
- NBC News, "Obamacare's rocky start: What you need to know," October 21, 2013
- Bloomberg, "Four things we think we know about Obamacare," October 18, 2013
- NBC News, "Obama administration clarifies dates related to health care rollout," October 23, 2013
- Fox News, "Surprise, surprise -- ObamaCare deadline extended yet again," March 26, 2014
- Washington Post, "Sebelius on health-care law rollout: 'Hold me accountable for the debacle. I'm responsible.'," October 31, 2013
- National Journal, "It's Official: Obamacare Enrollment Is Super Low," November 13, 2013
- ASPE Issue Brief, "Health Insurance Marketplace: November Enrollment Report," November 13, 2013
- Fox News, "HHS announces small extension for ObamaCare sign-up, bigger delay next year," November 22, 2013
- Washington Post, "Obamacare’s online SHOP enrollment delayed by one year," November 27, 2013
- New York Times, "Health Secretary Resigns After Woes of HealthCare.gov," April 10, 2014
- The Hill, "White House stands by Sebelius amid ouster calls over ObamaCare rollout," October 15, 2013
- Yahoo! News, "Obamacare website shows improvement, new problems emerge," October 14, 2013
- Politico, "Jeff Zients: HealthCare.gov working by end of November," October 25, 2013
- Department of Health and Human Services, "April Enrollment report," May 1, 2014
- Department of Health and Human Services, "March Enrollment Report," March 11, 2014
- Department of Health and Human Services, "February Enrollment Report," February 12, 2014
- Department of Health and Human Services, "January Enrollment Report," January 13, 2013
- Department of Health and Human Services, "December Enrollment Report," December 11, 2013
- Washington Post, "Who counts as an Obamacare enrollee? The Obama administration settles on a definition.," November 11, 2013
- Wall Street Journal, "Healthcare.gov Enrollment Falls Far Short of Target," November 11, 2013
- CBS News, "Obamacare enrollments got off to very slow start, documents show," October 31, 2013
- House Oversight Committee, "CCIIO-Wide War Room Notes"
- NPR, "Enrollments For The Healthcare Exchanges Trickle In, Slowly," October 21, 2013
- NBC News, "Obama: 'The Affordable Care Act is not just a website'," October 21, 2013
- The Hill, "O-Care stonewall: Media stymied (Video)," accessed November 5, 2013
- Washington Post, "Obamacare won’t get 7 million enrollees in 2014 — and that’s okay," November 26, 2013
- Politico, "Poll: Young least familiar with Obamacare," December 2, 2013
- Washington Post, "HealthCare.gov goal is for 80% of users to be able to enroll for insurance," November 19, 2013
- Washington Post, "Health insurance exchange launched despite signs of serious problems," October 21, 2013
- New York Times, "Bipartisan Dismay Over Health Plan Woes at House Hearing," October 24, 2013
- Politico, "White House didn't anticipate scale of problems with HealthCare.gov," October 23, 2013
- Hot Air, "CBS: White House warned three years ago that ObamaCare was running off the rails," accessed November 5, 2013
- Washington Post, "Private consultants warned of risks before HealthCare.gov’s Oct. 1 launch," November 18, 2013
- USA Today, "Obama adviser: Demand overwhelmed Healthcare.gov," October 6, 2013
- Chicago Tribune, "Computer glitches, overloads hit health care exchanges," October 1, 2013
- Bloomberg Businessweek, "The Obamacare Website Didn't Have to Fail. How to Do Better Next Time," October 16, 2013
- CNBC, "How bad are Obamacare tech hurdles? Real bad, poll finds," October 17, 2013
- Bloomberg, "Insurers Getting Faulty Data From U.S. Health Exchanges," October 8, 2013
- Politico, "Another obstacle to signing up for ACA crops up," October 21, 2013
- Wall Street Journal, "Health Website Woes Widen as Insurers Get Wrong Data," October 17, 2013
- CBS News, "HealthCare.gov pricing feature can be off the mark," October 23, 2013
- TechCrunch, "Healthcare.gov Ignores Birthdates, Dramatically Underestimates Prices," October 23, 2013
- Fox News, "Administration launches program to let users circumvent HealthCare.gov," November 25, 2013
- Politico, "Two weeks in, Obamacare website still broken," October 16, 2013
- Chicago Tribune, "Healthcare.gov data center back online after crashing," October 28, 2013
- Huffington Post, "Key Obamacare Data Hub Working Again After Day-Long Crash," October 28, 2013
- Reuters, "U.S. Obamacare data hub 'experiencing an outage', Connecticut says," October 29, 2013
- Department of Health and Human Services, "Marketplaces Faced Early Challenges Resolving Inconsistencies With Applicant Data," June 2014
- CNN, "5 things we learned from Sebelius Obamacare hearing," October 30, 2013
- Memo from James Kerr and Henry Chao to Marilyn Tavenner
- The Hill, "WH: No security risks on HealthCare.gov," October 31, 2013
- CNN, "Government memo warned of high security risk at health care website," October 30, 2013
- Yahoo, "Obamacare agency relies on manual back-ups as enrollment rises," December 11, 2013
- Reuters, "State Obamacare exchanges enroll 3 pct of target so far -report," November 11, 2013
- Sacramento Bee, "Healthcare sign-ups proceeding, at least in California," November 10, 2013
- CT Mirror, "Obama misspeaks about Connecticut health exchange," October 22, 2013
- The Courant, "Misinformation Marred First Month Of State Health Website," December 11, 2013
- Hawaii Reporter, "Hawaii’s Obamacare exchange relaunches with more glitches," October 16, 2013
- Wall Street Journal, "Maryland Health Exchange Director Resigns Amid Website Woes," December 7, 2013
- Westminster Patch, "Feds to Investigate Maryland Health Care Exchange Problems," March 10, 2014
- Boston Herald, "Mass. errors stymie Bay Staters’ sign-ups," November 8, 2013
- MPR News, "$0 credit subsidy confuses MNsure consumers," November 12, 2013
- Yamhill Valley News Register, "Cover Oregon clings to grand vision despite delays," November 10, 2013
- Politico, "Democrats blame big business for botched rollout," January 9, 2014
- VPR, "Shumlin Announces Major Healthcare Exchange Delay," October 31, 2013
- Kaiser Health News, "Washington State To 8,000 Obamacare Enrollees: We Goofed On Cost Estimate," November 11, 2013
- Politico, "Only 5 enrollments completed in D.C. Obamacare exchange," November 8, 2013
- USA Today, "Tech experts: Health exchange site needs total overhaul," October 17, 2013
- New York Times, "Contractors See Weeks of Work on Health Site," October 20, 2013
- Slate, "The One Disheartening Number That Suggests HealthCare.gov Will Not Be Fixed Anytime Soon," October 21, 2013
- Slate, "5 Million Lines of Obfuscation," October 22, 2013
- CNN, "To fix Obamacare website, blow it up, start over," October 23, 2013
- ComputerWorld, "Healthcare.gov website 'didn't have a chance in hell'," October 21, 2013
- Mother Jones, "Just How Bad Is the Obamacare Website, Anyway?," October 15, 2013
- Washington Post, "HealthCare.gov: How political fear was pitted aginst technical needs," November 2, 2013
- Politico, "Obamacare 'tech surge' has D.C. ties," October 31, 2013
- FCW, "Zients to lead HealthCare.gov reboot," October 23, 2013
- NBC News, "White House to adjust health care penalty deadline guidance," October 23, 2013
- USA Today, "Health chief Sebelius apologizes for botched website," October 30, 2013
- NBC News, "Did the feds fix Healthcare.gov? How we'll know," November 30, 2013
- NBC News, "Healthcare.gov down for overnight maintenance," November 29, 2013
- Washington Times, "Obamacare website ‘fixed,’ but label of failure sticks; more bumps expected, lawmakers are wary," December 1, 2013
- National Journal, "Obamacare 'Tech Surge' Draws From Google, Oracle," October 31, 2013
- Who is Jeffrey Zients, and how is he qualified to fix HealthCare.gov?, October 24, 2013
- HealthCare.gov, "HealthCare.gov," accessed November 5, 2013
- Politico, "Million visitors to HealthCare.gov," December 3, 2013
- USA Today, "White House claims success on HealthCare.gov repairs," December 1, 2013
- The Hill, "Carney hedges on whether ObamaCare mandate could be delayed," October 21, 2013
- Wall Street Journal, "Poorly Managed HealthCare.gov Construction Cost $840 Million, Watchdog Finds," July 30, 2014
- CBS News, "HealthCare.gov has already cost $840 million," July 30, 2014
- Fiscal Times, "Cost of Obamacare Website to Date: $292 Million," October 17, 2013
- Digital Trends, "We paid over $500 million for the Obamacare sites and all we got was this lousy 404 (updated)," October 8, 2013
- Sunlight Foundation, "How Much Did Healthcare.gov Actually Cost?," October 22, 2013
- Sunlight Foundation, "Good enough for government work? The contractors building Obamacare," October 9, 2013
- New York Post, "Obama donor's firm hired to fix Web mess it created," November 1, 2013
- Washington Post, "Meet CGI Federal, the company behind the botched launch of HealthCare.gov," October 16, 2013
- Reuters, "Insight: As Obamacare tech woes mounted, contractor payments soared," October 17, 2013
- NBC News, "Obamacare glitches: Gov't contract for troubled site has swelled; GOP targets Sebelius," October 18, 2013
- Washington Post, "HealthCare.gov contractor had high confidence but low success," November 23, 2013
- Washington Examiner, "Canadian officials fired IT firm behind troubled Obamacare website," October 10, 2013
- Toronto Star, "Gun registry contract canceled after $81M spent," November 8, 2007
- National Review, "More Questions about the Insurance Exchange Contractors," November 1, 2013
- National Review, "Serco's Checkered History," October 30, 2013
- Wall Street Journal, "Sebelius Calls for Review of Healthcare.gov Contracting Practices," December 11, 2013
- New York Times, "Administration Begins Search for New Contractors to Run Health Care Site," April 29, 2014
- CBS News, "Poll: Congress, tea party take hits from government shutdown," October 22, 2013
- Politico, "Contractors grilled on the Hill," October 24, 2013
- CNN, "Obamacare website administrator apologizes, says system works," October 29, 2013
- CNN, "Sebelius: 'I apologize, I'm accountable' for Obamacare website flaws," October 30, 2013
- U.S. News and World Report, "Healthcare.gov Concerns Lost Amid Partisan Sniping," November 13, 2013
- The Verge, "Congress grills admin officials as fears swarm that Healthcare.gov will not be ready in time," November 13, 2013
- Fox News, "Tech officials face questions on troubled HealthCare.gov launch," November 13, 2013
- Washington Post, "How much did Healthcare.gov cost (part 2)?," November 19, 2013
- New York Times, "Health Secretary Resigns After Woes of HealthCare.gov," April 10, 2014
- CNN, "Woman cited by President as Obamacare success story frustrated by sign up process," November 19, 2013
- Politico, "For Hollywood, the joke's on Obamacare," November 12, 2013
- Buzzfeed, "Obamacare's Grassroots Army Is Starting To Get Burned Out," October 30, 2013
- CNBC, "Nine Senate Dems push for Obamacare work-around," November 27, 2013
- Politico, "Kay Hagan seeks 'complete' Obamacare probe," November 11, 2013
- Washington Post, "10 Senate Democrats sign Shaheen letter pushing for open enrollment extension," October 25, 2013
- Washington Post, "32 House Republicans call for Sebelius's resignation," October 24, 2013
- BBC, "NHS IT system one of 'worst fiascos ever', say MPs," September 18, 2013
- Huffington Post, "Seven Alternatives to Healthcare.gov, Obamacare's Glitchy Website," October 16, 2013
- CNN, "Trio of young coders build health-care website in days," November 11, 2013
- Politico, "Why Kathleen Sebelius is safe," October 23, 2013
- Pittsburgh Tribune-Review, "Sebelius visit fails to reassure as health care website glitches persist," October 10, 2013
- The Hill, "Sebelius: Exchanges will be ready on time, no need for backup plan," April 12, 2013
- Washington Post, "Obama: HealthCare.gov working 'pretty well now'," November 26, 2013
- CNet, "Obama on HealthCare.gov bugs: Patience, even Apple has issues," October 1, 2013
- Politico, "Obamacare online glitches: 25 great quotes," October 15, 2013
- Politico, "Kathleen Sebelius offers to testify on Obamacare," October 22, 2013
- Politico, "Ted Cruz: Nigerian emailers run Affordable Care Act site," October 22, 2013
- Washington Times, "Second lawmaker calls on HHS Secretary Sebelius to resign over Obamacare woes," October 14, 2013
- Youtube, "Senator Roberts Call For Secretary Sebelius to Resign," October 11, 2013
- Politico, "Dems caught in Obamacare uproar," October 21, 2013
- Politico, "Competing views on Obamacare sink House debt ceiling plan — Baucus: Obamacare will get back on track," October 16, 2013
- Washington Post, "Many remain locked out of federal healthcare Web site," October 8, 2013