Feb. 25--We now know why the debut of the Obamacare health insurance shopping website was such a failure that only six people in the entire country got it to work well enough to select coverage on the day it launched in 2013.
A new study of the boondoggle describes a government machine running on autopilot to a destination of doom. Fragmented leadership refused to acknowledge the looming meltdown despite mounting evidence, then failed to change course until it was too late.
The www.healthcare.gov website, a tool critical to achieving the Affordable Care Act's goal of providing health insurance to all, faced "a high risk of failure" from the start because it was a complicated task on a fixed deadline, according to the study released Tuesday by the inspector general for the Department of Health and Human Services.
It ultimately failed because of several factors, the inspector general concluded, including poor technical decisions and wasting too much time developing policy and not enough time creating the website.
"The corrections were too weak and late to avert the poor outcome," the inspector general concluded.
The Centers for Medicare & Medicaid Services was in charge of building the site. It works now, but its debut was a disaster and a public relations nightmare for a politically charged program that many wanted to see fail.
The Affordable Care Act was signed into law in March 2010. It required the establishment of a website where people could shop for coverage. The government chose a launch date of Oct. 1, 2013, and never considered delaying that, even as the project deteriorated.
Work on the website started in 2010. During the first two years, the project suffered from communication breakdowns and needlessly complex implementation, the inspector general's report says. A key contract to develop the website was "mismanaged," and the project continued changing even as the deadline neared.
As with anything in Washington, politics interfered, too.
Some states balked at participating in Obamacare, creating uncertainties over whether states would build their own online marketplaces or rely on the federal one. Questions about future funding from Congress and the Supreme Court's review of the insurance mandate, which was not decided until 2012, also loomed over the project.
Senior leadership at the Centers for Medicare & Medicaid Services didn't assign one person to take overall responsibility for the job until near its end. Contractors on the project said the result was that they received "inconsistent direction" from multiple departments.
Some officials complained that the involvement of White House staff added to the bureaucracy and delayed decisions.
"This was the president's achievement," one CMS official told the inspector general. "It raised the stakes. It meant that people at my level had a lot of bosses."
A series of 18 reports that "documented warnings" about the website's shortcomings were prepared over two years, but they weren't shared broadly with those in charge and with technical staff.
In the months before the launch, officials finally saw the fire burning and tried to put it out. More staff was brought in. They scaled back the website's capabilities and delayed launching the Spanish version of the site and a companion site designed for small businesses.
But the fire kept spreading.
A month before the launch, problems were discovered with the website's coding, including incorrect versions and outdated code.
Four days before the deadline, officials realized that the website's capacity was far too limited to support the projected number of people who would be using it simultaneously. Officials drove to the offices of the main contractor and told them to double the capacity. The contractor pulled it off, but it still wasn't enough.
Healthcare.gov crashed within two hours of its launch on Oct. 1, 2013.
As many as 250,000 people had tried using it at once, much greater than the planned capacity, the inspector general said in its report. By the end of the day, only six people were able to submit an application and select a health plan.
Officials scrambled to fix the site, but it wasn't easy because the same day the site launched and crashed, the government shut down due to a lack of funding.
That ridiculous shutdown lasted 16 days. During that time, contractors continued working on the website but were hampered because many of their government counterparts were off the job.
Despite that hurdle, the website's performance improved dramatically and within two months was functioning more than 90 percent of the time, the inspector general said.
Correcting the defects was costly. The estimated cost of the six primary contracts on the job rose from $464 million to $824 million, the inspector general said.
In its written response to Tuesday's report, the Centers for Medicare & Medicaid Services did not dispute the inspector general's findings. It also didn't address them directly, noting only that the agency "was able to execute significant improvements within two months of launch."
The agency concurred with the inspector general's recommendation that it apply the lessons learned from the launch to its continued management of the healthcare.gov website, and the agency's broader work.
The Watchdog is published Thursdays and Sundays. Contact me at [email protected], 610-841-2364 or The Morning Call, 101 N. Sixth St., Allentown, PA 18101. I'm on Twitter @mcwatchdog and Facebook at Morning Call Watchdog.
BUSY FIRST DAY
Volume and glitches quickly swamped healthcare.gov as the government rolled out the website on Oct. 1, 2013. Between midnight that day and the next afternoon:
--2.8 million people went to the website.
--81,000 called the Affordable Care Act help number..
--60,000 requested live chats on the website.
Source: U.S. Department of Health and Human Services
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