Millions of Americans watched in eager anticipation as late last year, the federal health insurance marketplace’s website HealthCare.gov came online. As the centerpiece of President Obama’s plan to overhaul the healthcare system in America, the marketplace was supposed to allow for those millions of citizens who are either uninsured or underinsured to quickly and conveniently browse through a selection of insurance plans and enroll for coverage during the open enrollment period. As it’s now widely known, problems with HealthCare.gov left users frustrated, opponents of the Affordable Care Act beating their chests, and supporters scrambling to find out what went wrong.
A large portion of the disappointment that came from the site’s failures can be attributed to the massive marketing campaign aimed at selling the site to the public. Over $ 684 million was placed into developing print, television, and online advertising trying to highlight the site’s features and benefits, such as
- Comprehensive private and government health plan options
- Special insurance coverage considerations for the elderly and children
- High probabilities of qualifying for financial assistance
Yet perhaps the feature that advertisers tried to sell most was how easy the site would be to use. Many of the ads running promised turnaround times of a few minutes. Yet in most cases, users were required to wait at least that long in order to get error messages telling them that their requests couldn’t be processed at that time. This inability to deliver on the promise of exceptional site functionality is said to have directly attributed to the over 3 percent decrease that was observed in user satisfaction ratings for government websites in general according to the American Consumer Satisfaction Index.
What Went Wrong?
Most of the problems observed with HealtCare.gov weren’t with the site itself. Tens of millions visited and found its content to be sufficient and its page navigation to be about average. When users attempted to actually enroll for healthcare coverage was when things really started to get dicey. During registration, many reported having to wait for up to 10-15 minutes only to be directed to error pages saying that the content that they were requesting was unavailable or that the site didn’t recognize their login information. Site administrators attempted to stem the quickly-changing tide of public opinion by making themselves available to users via Twitter, yet those channels quickly became overwhelmed with complaints.
All of these issues led many to ask what went wrong. Given the availability that government officials overseeing the site’s development and many of developers involved in its creation gave to the media prior to the site’s launch, many thought that answers would be quickly forthcoming. In the end, they weren’t. Much of what was put forth were simply statements made by each entity involved trying to distance themselves from the problems, stating that those issues that users were experiencing had nothing to do with their work on the site. Development Seed, the firm tasked with creating much of the site’s front-end interface, had been remarkably open about their involvement prior to the problem’s arising. Now they’re quick to point out that the problems with the site have been shown to be piecemeal. Some may see their point given that most of the issues identified were linked to the back-end coding that handled the registration and enrollment functions of the marketplace. That task was contracted to the development firm CGI Federal, which remained remarkably tight-lipped during the entire process. Yet as other developers involved in the project quickly learned, users were judging the site in its totality.
Common Problems in an Uncommon Situation
Looking back, the problems that HealthCare.gov experienced are not all that uncommon in collaborative open source software development projects. Any time multiple web development firms are tasked with creating multiple pieces for a single end-to-end process, issues are bound to arise. That’s because while developers are quiet adept at getting their own code to work, they’re not always as successful at getting it to work with others. The end result is typically multiple parties creating their distinct pieces and then praying that they all work well in interfacing with each other. When they don’t, it’s often too late to fix problems before they can affect users.
Problems such as these occur with many open source coding projects. The obvious difference in the case of Healthcare.gov is that its promises and purpose brought its problems increased exposure. It also hasn’t helped that the source code created by certain developers involved, including CGI Federal, is seemingly nowhere to be found, a disturbing fact that flies in the face of the open source philosophy.
Changes in 2014
This past January, Accenture Federal Services was brought in to try and correct many of these issues in preparation for this year’s open enrollment period. Nearly $ 175 million was spent in correcting the back-end issues, and new contracting oversight officials were appointed to help ensure the site’s functionality met the promised standards. The early results of those efforts appears to be promising, as more than 460,000 have enrolled for coverage since the enrollment period began on November 1. Yet even with the lack of user complaints seen thus far, problems with the site have persisted.
In mid-October, the Centers for Medicare and Medicaid Services identified a potential data storage shortfall that could potentially produce some of the same problems that users encountered last year, namely system crashes, increased latency, and the loss of enrollment data. This prompted the government to contract Verizon Terremark to add 100 terabytes of cloud storage to help support the site’s operations during open enrollment. Already the cloud host for the Federally Facilitated Marketplace, Terremark was chosen without going through a bidding process due to the problem requiring an immediate solution in advance of the pending enrollment period.
The intended scope and scale of what HealthCare.gov is meant to accomplish means that high expectations for its performance are inevitable. Yet as is so often the case with any new large-scale project, problems will present themselves along the path to the site’s optimal performance. While great effort was put into overcoming the site’s shortcomings that were manifested during last year’s open enrollment period, unanticipated problems such as the lack of adequate storage capacity seem sure to continue to plague the site in its immediate future. The early results seem to offer some hope, yet even site administrators acknowledge that it’s still not quite at the point of being perfect.
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