Regardless of your political position, in October of last year it was clear that Healthcare.gov was not working the way it should have. The federally facilitated marketplace website made signing up for health insurance difficult, denied coverage for many who should have been eligible, and repeatedly crashed.
While many were quick to blame these errors on the federal government, private technology companies were also at fault. The primary vendor was CGI, a Canadian information technology consulting company that had been awarded the largest contract of about $88 million.
From a purely technological standpoint, the main reason Healthcare.gov failed was because it was built on a weak software foundation. CGI's website simply could not handle the amount of traffic the website experienced. Also, many commonly used coding techniques that maximize website efficiency were not used. As a result of these failures, the federal government terminated the contract with CGI in January 2014.
In CGI's defense, some of the website's problems can be attributed to the complex relationship between CGI, the federal government, and other vendors. While CGI did have the largest contract, more than 50 other vendors worked on Healthcare.gov. The more companies designing a website, the less likely it is that it will function in a unified and efficient manner. Some of the more successful state-based marketplaces, such as Kentucky and California, contracted with only two or three vendors.
One problem for CGI was that the Department of Health and Human Services had not issued explicit specifications for the website in enough time for the company to do its job. Another major issue was funding. A report by the Government Accountability Office noted that the federal government awarded a total of $394 million in contracts that were split among more than 50 companies to design and maintain the federal exchange website. And that one site had to accommodate consumers from more than half of the states.
By comparison, California awarded $359 million for both the initial creation and 3 1/2 years of maintenance for a website that would serve only one state.
During the second open enrollment period beginning in November, Healthcare.gov should run more smoothly than it did the first time. The Centers for Medicare & Medicaid Services issued rules in May of 2014 that provide more direction to vendors than the agency had given prior to the first open enrollment period. Healthcare.gov will now be run by Accenture, the vendor that was largely responsible for fixing the most serious problems the first time. The federal government recently awarded Accenture an additional $90 million to maintain Healtcare.gov this upcoming year.
With new regulations, enhanced funding, and a new company at the helm, Healthcare.gov may be able to avoid many of the disasters that plagued it under CGI.
However, glitches are inevitable in any project of this size. The measure of success is how much more smoothly the website functions this time. It is too soon to expect perfection.
Matthew Maughan is a third year student at the Thomas R. Kline School of Law at Drexel University concentrating in health law.
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