HealthCare.gov is a health insurance exchange website operated by the United States federal government under the provisions of the Affordable Care Act (ACA), informally referred to as "Obamacare", which currently serves the residents of the U.S. states which have opted not to create their own state exchanges. The exchange facilitates the sale of private health insurance plans to residents of the United States and offers subsidies to those who earn between one and four times the federal poverty line, but not to those earning less than the federal poverty line.Explaining Health Care Reform: Questions About Health Insurance Subsidies, KFF, November 20th, 2018 The website also assists those persons who are eligible to sign up for Medicaid, and has a separate marketplace for small businesses.
On October 1, 2013, HealthCare.gov was rolled out as planned, despite the concurrent partial government shutdown. The launch was marred by serious technological problems, making it difficult for the public to sign up for health insurance. The deadline to sign up for coverage that would begin January 1, 2014, was December 23, 2013, by which time the problems had largely been fixed. The open enrollment period for 2016 coverage ran from November 1, 2015, to January 31, 2016. State exchanges also have had the same deadlines; their performance has been varied.
The design of the website was overseen by the Centers for Medicare and Medicaid Services and built by a number of federal contractors, most prominently CGI Inc. of Canada. The original budget for CGI was $93.7 million, but this grew to $292 million prior to launch of the website. While estimates that the overall cost for building the website had reached over $500 million prior to launchWe paid over $500 million for the Obamacare sites and all we got was this lousy 404 by Andrew Couts, Digital Trends, October 8, 2013 and in early 2014 HHS secretary Sylvia Mathews Burwell said there would be "approximately $834 million on Marketplace-related IT contracts and interagency agreements," the Office of Inspector General released a report in August 2014 finding that the total cost of the HealthCare.gov website had reached $1.7 billion and a month later, including costs beyond "computer systems," Bloomberg News estimated it at $2.1 billion. On July 30, 2014, the Government Accountability Office released a non-partisan study that concluded the administration did not provide "effective planning or oversight practices" in developing the HealthCare.gov website.
Background and functionality
The site functions as a clearing house to allow Americans to compare prices on health insurance plans in their states, to begin enrollment in a chosen plan, and to simultaneously find out if they qualify for government healthcare subsidies. Visitors sign up and create their own specific user account first, listing some personal information, before receiving detailed information about what is available in their area. Designed to assist the millions of uninsured Americans, the comparison shopping features involve a visual format somewhat analogous to websites such as Amazon.com and Etsy.
HealthCare.gov also details Medicaid options for individuals. This relates to an expansion of the long-running program undertaken as a joint effort under the ACA. The Congressional Budget Office (CBO) projected that the exchange would be used by an estimated seven million Americans to obtain coverage during the first year after its launch; current estimates suggest that the combined figure is slightly above eight million.
Development and history
President Barack Obama signed the Affordable Care Act (ACA) into law on March 23, 2010, in the East Room before a select audience of nearly 300 people. He stated that the health reform effort, designed after a long and acrimonious debate facing fierce opposition in the Congress to expand health insurance coverage, was based on "the core principle that everybody should have some basic security when it comes to their health care". The primary purpose of the ACA was to increase coverage to the American people either through public or private insurance and control healthcare costs. The Congressional Budget Office (CBO) estimated that the ACA would reduce the number of uninsured by 32 million, increasing coverage for the non-elderly citizens from 83 to 94 percent. Insurers were not allowed to deny insurance to applicants with pre-existing conditions. The Sunlight Foundation has stated that at least forty-seven private company contractors have been involved with the ACA in some capacity as of fall 2013, with the measure causing a wide variety of policy changes. Journalists writing for The New York Times have called the ACA "the most expansive social legislation enacted in decades".
A report by Reuters described HealthCare.gov itself as the "key" to the reform measure. Development of the website's interface as well as its supporting back-end services, to make sure that the website could work to help people compare between health insurance plans, were both outsourced to private companies. The front-end of the website was developed by the startup Development Seed. The back-end work was contracted out to CGI Federal Inc., a subsidiary of the Canadian IT Multinational corporation CGI Group, which subcontracted the work to other companies, as is common on large government contracts. CGI was also responsible for building some of the state-level healthcare exchanges, with varying levels of success (some did not open on schedule).
According to author and journalist John J. Xenakis, CGI Federal's attempt in Massachusetts is characterized as a complete failure. In Xenakis' view, despite the Massachusetts connector being the type of website which a small team of five to ten could create in a few months on a 10 million dollar budget, a team of around 300 with a 200 million dollar budget failed. Xenakis claims CGI Federal were likely to have hired many incompetent programmers due to Massachusetts transferring the development contract to another firm, Optum. The software created by CGI was of poor quality and unusable by Optum, who had to start from scratch. CGI has also been accused of committing fraudulent tests and reports to those in charge of oversight. Similar problems occurred in many other states.
Specifically, aspects of HealthCare.gov relating to digital identity authentication were assigned to Experian. Quality Software Services, Inc. (QSSI) also played a role. The total number of companies enlisted in the website's creation, and their names, has not been disclosed by the Department of Health and Human Services. The whole effort was officially coordinated by the Centers for Medicare and Medicaid Services (CMS), an agency that commentators such as journalists David Perera and Sean Gallagher have speculated was ill-suited to that task. Social activist and technologist Clay Johnson later said that the federal government had issues come up given that it "leans towards a write-down-all-the-requirements-then-build-to-those-requirements type of methodology" not well suited to current IT especially when government contractors are focused on maximizing profits.
"The firms that typically get contracts are the firms that are good at getting contracts, not typically good at executing on them," Alex Howard, a fellow at the Harvard Ash Center for Democratic Governance and Innovation, remarked to The Verge as he evaluated the back-end of the project. In contrast, the web-magazine's journalist Adrianne Jeffries praised the successful use of an "innovative" startup business for the front-end. However, she found the overall rollout "bone-headed".
The Obama administration repeatedly modified regulations and policies until summer 2013, meaning contractors had to deal with changing requirements. However, changing requirements are by no means unusual in a large, expensive custom software project; they are a well-known factor in historical project failures, and methodologies such as agile software development have been developed to cope with them. Unfortunately, regulations pertaining to large government contracts in many countries, including the United States, are not a good match for agile software development.
Statistics Analysis by the Reuters news agency in mid-October stated that the total contract-based cost of building HealthCare.gov swelled threefold from its initial estimate of $93.7 million to about $292 million. In August 2014, the Office of Inspector General released a report finding that the cost of the HealthCare.gov website had reached $1.7 billion. As pointed out later by commentators such as Mark Steyn, the CGI company had already been embroiled in a mid-2000s controversy before over contract payments. While devising the Canadian Firearms Registry, estimated costs of $2 million ballooned to about $2 billion.
On March 25, 2019, the Centers for Medicare and Medicaid Services reported that 11.4 million Americans had selected enrolled in or automatically renewed their Exchange coverage during the 2019 Open Enrollment Period.
Concerns about the website Issues during launch
The HealthCare.gov website was launched on the scheduled date of October 1, 2013. Although the government shutdown began on the same day, HealthCare.gov was one of the federal government websites that remained open through the events. Although it appeared to be up and running normally, visitors quickly encountered numerous types of technical problems, and, by some estimates, only 1% of interested people were able to enroll to the site in the first week of its operations. Even for those that did manage to enroll, insurance providers later reported some instances of applications submitted through the site with required information missing.
In Bloomberg Businessweek journalist Paul Ford summed up the issue by remarking, "Regardless of your opinions on the health-care law, this is the wrong way to make software." He also wrote, "In the meantime, it's clear that tens of millions of dollars have been spent to launch something broken." A ConsumerReports.org article re-iterated previous advice, with the group recommending for people to stay "away from HealthCare.gov for at least another month". The group stated as well, "Hopefully that will be long enough for its software vendors to clean up the mess they've made."
In its third week of operations, technical problems continued. A CNN.com article highlighted the "maddeningly long wait times" as an issue. A variety of other problems included broken pull-down menus that have only worked intermittently, for example.
Todd Park, the U.S. chief technology officer, initially said on October 6 that the glitches were caused by unexpected high volume when the site drew 250,000 simultaneous users instead of the 50,000-60,000 expected. He claimed that the site would have worked with fewer simultaneous users. More than 8.1 million people visited the site from October 1 to 4. White House officials subsequently conceded that it was not just an issue of volume, but involved software and systems design issues. For example, consumers are required to create an account before being able to compare plans, and the registration process may have created a bottleneck that led to the long wait times. Also, stress tests done by contractors 1 day before the launch date revealed that the site became too slow with only 1,100 simultaneous users, nowhere near even the 50,000-60,000 expected.