The website healthcare.gov was launched on october 1 2013
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Healthcare.gov is the website published by the federal government that is intended to serve as the central online hub for the rollout of the federal government's Patient 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.[1] The English-language version of Healthcare.gov website went live on October 1, 2013. The launch of a Spanish-language version was delayed.[2] 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 was either $95 or 1 percent of income, whichever was greater.[3] The White House stated anyone selecting a plan before the deadline would not be subject to the penalty.[4] 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.[5]
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."[6] 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.[7][8] On November 22, 2013, the Obama administration announced an eight-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 was pushed back from the original October 15 start date to November 15, 2014, just after midterm elections.[9] 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 had to use an insurance broker to sign up for eligible plans. The small business program delay did not impact states with state-run exchanges.[10] On April 10, 2014, Kathleen Sebelius resigned from her post as a result of the troubled rollout of Obamacare.[11] Website usageThe federal government expected that seven million Americans who were previously uninsured would 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.[12][13] The administration expected about 500,000 enrollees by the end of October 2013, but only 106,185 were enrolled.[7] 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 percent, but there were still problems completing applications, where "[a]s few as three out of 10" were accepted.[14] Number of website visitors
Number of enrolleesMarch/April enrollment official reportThe official report for the closing of the open enrollment period was released May 1, 2014. Below are some notes from the report:
February enrollment official reportThe official report for February enrollment was released March 11, 2014. Below are some notes from the report:
January enrollment official reportThe official report for January enrollment was released February 12, 2014. Below are some notes from the report:
December enrollment official reportThe official report for December enrollment was released January 13, 2014. Below are some notes from the report:
November enrollment official reportThe official report for November enrollment was released December 11, 2013. Below are some notes from the report:
October enrollment official reportThe 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.[20] The official report stated 106,000 people enrolled in plans through the state and federal exchanges.[7] Below are more notes from the report.
Early enrollment estimates
Enrollment goalsThe federal government expected that 7 million Americans who were previously uninsured would buy a health insurance plan by the end of the first enrollment period on March 31, 2014. The White House hoped that about 2.7 million of the enrollees would be young adults in order to offset the costs of insuring those with pre-existing conditions. Ezra Klein of the Washington Post, wrote on November 26, 2013 that in order for the law to be successful, 39 percent of the new signups should 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. However, in 2015 the RAND Corporation released an analysis showing that premiums would only increase by about 3 percent if the government failed to meet its enrollment goals for young adults.[26][27][28] FOIA request filed by media outletsA 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." President Obama had hinted that he was aware of enrollment figures, with speeches that allude to "thousands" having signed up since the launch of the website.[29] Increased funding for minority enrollmentHHS announced the Partnership to Increase Coverage in Communities on September 11, 2014, which was established to disburse funding to organizations focused on helping minorities enroll in healthcare coverage. The Centers for Disease Control and Prevention estimated that only 40 percent of Latinos and 25 percent of African Americans were enrolled following the first enrollment period. The director of the Office of Minority Health stated, "Racial and ethnic minorities have lower rates of health insurance coverage than the national average and stand to benefit greatly from the Affordable Care Act."[30] Type of enrolleesEzra 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 percent 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.[31] Awareness polling
Project benchmarksAccording 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 percent of signups. The team of presidential innovation fellows assigned to help fix the site, noted that in order to meet the goal of 80 percent, the error rate for the website would need to be under 1 percent and the average load time needed to be less than half a second per page.[33] Pre-launch testing
Problems were knownAccording 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."[37] Independent pre-launch assessmentThe 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."[38] Issues with rolloutEligibility verificationThe Government Accountability Office (GAO) conducted a sting operation on the verification system of the federal health insurance exchange in which they submitted fake account information while signing up. The verification system allowed 11 of the 18 fake accounts to sign up for subsidized health insurance. The GAO tried telephone, online, and in-person signups. The attempts at using in-person navigators failed. Several Republican members of Congress requested the operation prior to the Healthcare.gov website rollout. Acting Director of Forensic Audits Seto Bagdoyan stated that the investigation was ongoing and members of Congress couldn't draw any conclusions from the small sample size. Bagdoyan admitted that the sample raised questions about the effectiveness of the verification program but did not suggest that the sting was any more than a small sample.[39][40] New accounts and logging inIn its first week, the website attracted as many as 250,000 users at a time. This exceeded administration estimates of between 50,000 and 60,000 simultaneous users.[41] 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.[42] 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.[41] In the first week, only 1 percent of the estimated 3.7 million people who tried to register actually enrolled in a plan.[43] CNBC published a survey on October 17 conducted by uSamp, an online market research firm. This survey found that 20 percent of those surveyed were able to log onto Healthcare.gov without experiencing technical issues.[44] 830 people were surveyed:
Data transfer problemsOnce users enrolled in the process, Bloomberg reported insurance companies were receiving incorrect information from the Healthcare.gov exchanges. The information passed on to the insurance companies was often either in inoperable files or missing vital information.[45] Other issues included the exchanges sending multiple files for each enrollee, mixing enrollments and cancellations and reporting spouses as children.[46][47] Some companies resorted to re-entering data by hand to correct the errors. The companies feared that if the website was fixed, allowing all users to enroll, the flood of bad data could have lead to major problems.[45] Errors in price quotesOn October 20, 2013, the administration released the new "shop and browse" feature, 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 gave 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 claimed the quotes were misleading and useless.[48] In general, the Healthcare.gov website understated actual prices due to this system error. As an example of the error caused by this website feature, CBS News found that Healthcare.gov estimated that a 48-year-old resident of North Carolina who was not subsidy-eligible would have had to pay $231 a month for a silver-level plan. However, the actual price was $360 a month.[49] Direct enrollmentInsurers and the federal exchanges were 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 October 2013.[46] On November 22, 2013, the Centers for Medicare and Medicaid Services (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.[50] Transfers from MedicaidOn November 1, 2013, the federal exchange had to transfer Medicaid applications and beneficiaries to state agencies. Bobby Peterson, executive director of ABC for Health in Madison, Wisconsin, said this date posed 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."[51] Data hub outagesA tweet by @zbyronwolf captured Sebelius and the struggling website on CNN during her hearing October 30, 2013. 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.[52] Verizon and the Department of Health and Human Services declined to comment.[53] 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, uses 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."[54] Post-enrollment period data inconsistenciesThe 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 Services 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."[55] Website outagesDuring Sebelius' 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 used the term as a synonym for "the website isn't working." Sebelius, however, advanced the perspective that the website had 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."[56] Security concernsHighly-placed government IT officials from the Centers 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."[57] Security flaws were said to pose a risk of compromising the privacy of social security numbers and birth dates.[58] 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."[59] 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."[58] Manual back-up systemsOn 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."[60] State exchange enrollment problemsFourteen states elected to create their own healthcare exchanges. As of November 12, 2013, signups had reached only 3 percent of their expected enrollment numbers in the 12 states where exchanges were "mostly working smoothly."[61] Following is a list of some problems the individual state exchanges faced.
Analysis of website problemsA number of theories have been put forward to explain the observed problems with Healthcare.gov. Outdated technologyThe "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."[75] CMS level of expertiseThe 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.[76] Lines of codeSlate 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.[77] 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' 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.[78] 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."[79] Size of projectComputerWorld, on October 21, reported on a study of websites costing over $10 million. The study showed that of 3,555 projects in the public and private sector, only 6.4 percent were successful. Over 50 percent of those projects suffered problems, such as going over budget, past deadlines or lack of user satisfaction.[80] Rigid deadlineKevin 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."[81] Last-minute design changesGail Wilensky, a health analyst who is a former administrator of CMS, 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."[79] Lack of fundsDon Berwick, a former administrator of CMS 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."[51] InsularityWhen 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 through to fruition the bill they worked so hard to pass. 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."[82] Fragmented constructionThe 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 patched 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.'"[82] High-level meeting attendanceStarting 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.[82] Political pressureMany states 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.[82] 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."[82] Efforts to fixProposed fixesThe 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:
Change the sign-up deadlineThe White House announced late on Wednesday, October 23, 2013, 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 were 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.[85] Estimated time to fix
Tech surge to fixOn October 30, 2013, CMS officials claimed the "tech surge" to repair Healthcare.gov included "dozens" of people from the private and public sectors.[90] Head of surgeOn October 23, 2013, the Obama administration announced Jeffrey Zients would lead the tech surge to fix Healthcare.gov.[84] Zients had led private companies like Sirius/XM Satellite Radio, Bain & Company management consulting, and Revolution Health, as well as held public offices in the Office of Management and Budget and led a trade and export reform for the Obama administration in 2011.[91] 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.[14] Team membersThe 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 had connections to the Obama administration in the past.[83] The administration did not release the full list of participants in the "tech surge."[90]
Website daily down timeA banner on Healthcare.gov alerted users of a daily down time from 1 a.m. to 5 a.m. EST. The banner stated: "Additional down times may be possible as we work to make things better."[92] Fix resultsFollowing the initial tech surge ending November 30, 2013, new fixes were introduced to the system.
Post-rollout issuesJuly 2014 hackerOn September 4, 2014, the Wall Street Journal released a report that Healthcare.gov had been hacked in July 2014. HHS discovered the attack in late August, though it was believed no significant damage was done. The department released a statement, explaining, "Our review indicates that the server did not contain consumer personal information; data was not transmitted outside the agency, and the website was not specifically targeted. We have taken measures to further strengthen security." The U.S. Department of Homeland Security, Federal Bureau of Investigation and National Security Agency began an investigation once briefed by HHS. It was discovered that the hacker installed malware on the Healthcare.gov server, but as far as investigators could tell, no information was compromised.[95] Members of Congress were concerned that access was gained to the server as easily as it was. Sen. Orrin Hatch (R-UT) criticized the site's security protocol, stating, "Despite numerous warnings from myself and other lawmakers that security breaches were possible, HealthCare.gov underwent virtually no independent security testing. … It’s yet another deeply disturbing failure of the president’s health law, and once again it is the American people who are bearing the brunt of the law’s failures." Sen. Tom Carper (D-DE) also spoke out but mentioned Congress' need "to reform our laws to better combat attacks from malicious actors and comprehensively address our serious cyber challenges to protect our nation, its people, its critical infrastructure, and its economy."[96] Rep. Darrell Issa (R-CA) called for a hearing on the matter on September 18, 2014, explaining, "For nearly a year, the administration has dismissed concerns about the security of HealthCare.gov, even as it obstructed congressional oversight of the issue. The committee will continue to push for answers from the administration and administrator Tavenner must testify on the subject of transparency, accountability, and information security alongside the Government Accountability Office at our Sept. 18 hearing."[97] CEO appointedIn an attempt to be better prepared for the second enrollment period, which began November 14, 2014, HHS Secretary Sylvia Burwell established the position of chief executive officer of Healthcare.gov on August 26, 2014. She appointed the creator of the Connecticut state healthcare exchange, Kevin Counihan, to head to federal website due to the relative success achieved by the state's website. A chief technology officer position was also created.[98] PenaltiesThe penalty for not being enrolled in a health insurance plan by March 31, 2014, was a charge of either $95 per person or 1 percent of household income, whichever was greater.[3] White House Press Secretary Jay Carney would not say on October 21, 2013 whether the struggles of the website would delay the individual mandate.[99] The administration announced in March 2014, that uninsured users could still enroll in April, paying their first premium, to avoid the penalty as long as a plan was selected by March 31, 2014.[5] CostsGAO investigation resultsThe 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.[100] 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.[101] Project estimates
ContractorsAccording to the Sunlight Foundation, the ten highest paying initial federal contracts for the website are listed below:
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.[34][106] The New York Post estimated QSSI had been paid $150 million as of November 1, 2013, but acknowledged more may have been on the way for the website fixes.[106] Connections to the administrationThe company was bought in 2012 by UnitedHealth Group, one of the largest health insurance companies in the United States. 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.[106] CGI GroupCGI Group, the parent company of Healthcare.gov contractor CGI Federal, was the 29th largest federal IT contractor in 2012, totaling 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."[107] CGI Federal was given six contracts by CMS for Healthcare.gov to build the shopping and enrollment aspects.[34] 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.[108] 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.[109] Pre-flight checklistAccording 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.[110] Past government contracts
Connections to the administrationCGI 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 campaigns.[113] SercoSerco 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.[114] Scandals
Contracting practices investigationOn 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 what happened with the website rollout. She also announced the creation of a chief risk officer position in the Centers for Medicare and Medicaid Services.[115] New contractor searchIn 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."[116] Public opinion
Congressional hearingsContractor hearingsUnitedHealth 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:[35]
Marilyn Tavenner hearingMarilyn Tavenner, the head of the Centers of Medicare and Medicaid Services, testified before the House Ways and Means Committee on October 29, 2013. CMS was responsible for Healthcare.gov's creation. Following are some issues that came up during her testimony:[119]
Kathleen Sebelius hearingSecretary 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:
IT specialist hearingOn 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.[121] Following are some of the topics raised at the hearing.
Sebelius resignationOn 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.[125] Possible ramificationsMiscalculated eligibility frustrationsJessica 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-level 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-level plan or $324 for a bronze-level 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."[126] Popular media blowbackWhile 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.[127] Supporter moraleBarack 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 nonprofits aimed at walking consumers through the new process, struggled 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.[128] Congressional pushbackDirect enrollment lettersEight 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 stated 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:[129] Senator Mark Pryor (D-AR) wrote his own, similarly focused letter to the administration.[129] Investigation into Healthcare.gov rollout failureSen. 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."[130] Individual mandate extension letterOn 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."[131] The signers of the letter were:[131]
Letter for Sebelius' resignationOn 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."[132] Those who signed the letter include:[132]
International government-run healthcare IT comparisonsEngland
Canada
Alternatives to Healthcare.gov for insuranceThe alternative ways to become compliant with the ACA without using the Healthcare.gov website include:[134]
Health SherpaThree 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."[135] ReactionsExecutive branch
CongressRepublicans
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Media
Recent newsThis section links to a Google news search for the term Healthcare.gov + website + issues See also
External links
Footnotes
When was HealthCare.gov launched?1 October 2013
What went wrong with the HealthCare.gov website?High website demand (250,000 users [5 times more than expected]) caused the website to go down within 2 hours of launch. While website capacity was initially cited as the main issue, additional problems arose mainly due to the website design not being complete.
Is HealthCare.gov a legit website?Spend some time with HealthCare.gov to learn the basics about getting health coverage. It's the official Marketplace website. Compare insurance plans carefully before making your decision. If you have questions, contact the Marketplace Call Center.
When did Obamacare website launch?Website Rollout
Healthcare.gov was officially launched on 1 October 2013 covering residents of 36 states that did not create and manage their own healthcare exchange. Problems with the website were apparent immediately.
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