Policy & Law
The more we learn about the development of Healthcare.gov, the worse the situation looks. The site has been serving myriad errors since it launched, including preventing users from creating accounts, failing to recognize users who do have accounts, putting users in inescapable loops, and miscalculating healthcare subsidies. While the administration is claiming a 50 percent reduction in wait times after adding new servers, other serious issues persist.
"I've got an application right now that's like half done, but I have four copies of my wife in it and can’t get rid of it and can’t start a new application," says James Turner, a software engineer and former systems administrator who wrote a critique of Healthcare.gov. "It's pretty clear that they didn’t do a lot of testing, because it's easy to get into states where you can’t get any further or you have bogus data you can’t get rid of."
It’s still unclear exactly what’s wrong with the government’s new online healthcare exchange, because the code isn’t public and errors make it difficult to see even the front-facing parts of the site. However, it’s now obvious that the site launched before it was ready.
"It's pretty clear that they didn’t do a lot of testing."
Developing a site that communicates with multiple government agencies and state-based sites isn’t easy. Healthcare.gov was also built on a tight deadline. But for an administration that seemed to have a deep understanding of the internet, the site was shockingly bad.
To start, Healthcare.gov wasn’t built by the elite team that built Obama’s campaign tech. The main $93.7 million contract to build the exchange was awarded to CGI Federal Inc., a subsidiary of the behemoth Canadian firm CGI Group. As is common with large contracts, CGI subcontracted with other megafirms for different aspects of the site. User authentication and identity is being handled by Experian. The "federal data services hub" was built by Quality Software Services, Inc. (QSSI was also accused of having a conflict of interest after it was bought by UnitedHealth Group.)
The Department of Health and Human Services declined to provide a full list of the contractors, citing shortages in the press office due to the government shutdown. The total number of companies looks to be between 12 and 15, says Alex Howard, a fellow at the Harvard Ash Center for Democratic Governance and Innovation who has been closely following the Healthcare.gov launch.
Government contracts are usually awarded to the lowest bidder, and the disincentives for not delivering aren’t very strong. There are also a number of extra requirements for government contracts that made state-of-the-art, Silicon Valley-style development impossible for this scale of government project. For example, contractors that worked on the Healthcare.gov backend were probably required to have Federal Information Security Management Act certification, which rules out the smaller, more agile firms that could have brought a more innovative sensibility to the project.
Healthcare.gov wasn’t built by the elite team that built Obama’s campaign tech
The process for getting these contracts has become so difficult and convoluted that the job doesn’t always go to the company best suited for it, Howard tells The Verge. "The firms that typically get contracts are the firms that are good at getting contracts, not typically good at executing on them," he says.
If the backend of Healthcare.gov reminded us that the government makes terrible websites, the front end actually proved the opposite. The first part of Healthcare.gov launched back in June as a front-facing site with information about the Affordable Care Act. The government hired Aquilent, a web development shop that handles a lot of government contracts, but after that the process took an unconventional turn. Aquilent subcontracted with an innovative Washington, DC, startup called Development Seed. Web designer Ed Mullen was pulled onto the project after he tweeted a mockup of what he thought the new site should look like, along with consultants from the hip design house Teal Media.
The scrappy team used principles of "agile development," a rapid and lean style that’s been en vogue in Silicon Valley the past few years, and even published its code on the open source repository Github. The resulting Healthcare.gov, part one, was lauded for nailing both form and function "in a decidedly 21st-century way: cheaper, faster and scalable, using open source tools and open standards," as Howard wrote at the time.
John Pavley, CTO of The Huffington Post, was disappointed when the administration didn’t open source the code behind the second part of the site, the health insurance exchange, the way it did for the first part. The government should have used an internal team supplemented by the open source community instead of relying on large contractors, he says.
"I was talking to some of my engineers about how we would love to be able to pitch in a few bug fixes or help with some open source code of our own," he tells The Verge. "I heard so many good things when the Obama administration came in, but if we're going to continue to build software this way it's going to continue to fail."
"I heard so many good things when the Obama administration came in."
The healthcare exchange that launched last week was designed for 50,000 to 60,000 concurrent users, but got 250,000, US chief technology officer Todd Park told USA Today in one of the only explicit statements the administration has made acknowledging the tech issues.
As of late Monday afternoon, the site was still sporadically overloaded, preventing users from starting an application for health insurance. Fixes for the design bugs are slowly trickling in; for example, the site no longer shows blanks in some dropdown menus.
Citizens have until December 15th to buy health insurance, or face paying a penalty. Until then, Healthcare.gov is in what amounts to a very public beta test. The Department of Health and Human Services, which oversees the healthcare exchange at Healthcare.gov, is not releasing the number of people who have successfully enrolled. The number is likely in the "low thousands," reports The Wall Street Journal.
Technical experts say the bugs will likely be ironed out soon, but the damage may already be done. "The most important time for a new website is the first three months," Pavley says. "After that, people don’t go back."
Others believe the rocky launch will soon be forgotten. "It’s worth remembering what happened during the implementation of Medicare Part D," wrote Paul Smith, co-founder of EveryBlock and CTO of Public Good Software. "There were many of the same types of reports, from pharmacies that couldn’t connect to government data services, to seniors that were temporarily unable to receive their benefit. Do we think about those stories now when we think about Part D? Of course not."
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