The making of an Obamacare management failure
By: Carrie Budoff Brown
November 12, 2013 11:28 PM EST
In the days after HealthCare.gov went live, White House chief of staff Denis McDonough quietly dispatched Jeff Zients, a favorite West Wing fixer, to assess the operation and report back.
When Zients did, President Barack Obama learned the project was in worse shape than suspected — riddled with coding problems, management issues and communication gaps, according to a senior administration official.
It was only then that Obama and his top aides realized the extent of what they didn’t know.
The story of how a technology-obsessed White House failed to head off a technological disaster may be as simple as it is mind-boggling to the law’s supporters. Senior White House officials claim they just never anticipated the magnitude of the problems that would unfold — there was concern, yes, but not an impending sense of doom.
The notion that Obama wasn’t clued in seems to defy logic, given the warning signs from both within the administration and outside it, the importance of the law’s success to his presidency and his own understanding of the power of technology. But ever since the troubled launch, administration officials have tried to keep Obama as far as possible from the debacle, describing him as engaged in the implementation but unaware of the depth of the website issues.
The question of how much the White House knew will get a fuller, public airing Wednesday when technology officials in charge of the website testify before House Oversight and Government Reform Committee.
Inside the West Wing, the explanation is that the things they were worried about didn’t turn out to be their biggest problem. Officials fretted over server capacity, rate shock, premium increases, the readiness of the state exchanges and driving traffic to the site — but not the fundamental health of the website.
Obama’s main line to the people working most directly on the project were his monthly meetings with Health and Human Services Secretary Kathleen Sebelius, Centers for Medicare & Medicaid Services director Marilyn Tavenner and other top officials, including White House chief technology officer Todd Park, who will testify Wednesday. They met more frequently in the weeks before the launch, and Obama pressed for unvarnished assessments, but the White House didn’t receive signals that a website fiasco was looming, aides said.
He tried to convey that his staff needed to bring problems to his attention before they spun out of control. Obama even told them that unless they got HealthCare.gov right, nothing else mattered. The response he got, aides said, was that it would work.
In the final weeks, White House aides often heard of flare-ups but they would quickly receive explanations for how the problem was resolved. They didn’t feel knowledgeable enough about IT issues to determine whether the solution was adequate, aides said.
A CMS spokeswoman declined to comment for this story.
In an Obamacare briefing for POLITICO four days before the launch, senior administration officials dismissed insurance industry concerns about the technology.
One official said during the briefing that he had learned a lot about software fixes and patches but that they were moving closer by the day to a good consumer experience. The official acknowledged that there would be glitches but that they felt very good about where they were on the operations side.
“There was a belief within the Department of Health and Human Services that the website would work and that the reports we were getting and others who strongly support the ACA was, sure, there were likely to be glitches,” said Ron Pollack, the founder of Enroll America, which has spent millions promoting the law. “But I don’t believe that anyone with major responsibility for the ACA implementation knew the problems would be as significant as they turned out to be.”
Yet there was palpable concern.
Two federal officials with direct responsibility for the federal insurance marketplace hinted back in March of a potentially dysfunctional system.
Speaking at the national policy meeting of America’s Health Insurance Plans, Henry Chao, a CMS official who oversaw the technology development, said the short time line for standing up the exchanges had made him “pretty nervous.”
“The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” Chao said, according to a CQ report from the conference. “Let’s just make sure it’s not a Third World experience.”
Chao is scheduled to testify Wednesday at the House hearing.
Gary Cohen, director of the CMS office charged with implementing the law, said at the conference that the agency might need to implement “contingency plans.” But, he said, “as we move closer to October, my hopes are the range of things that could go wrong gets narrower and narrower.”
The Government Accountability Office report in June warned that, although the agency had met project schedules, “several critical tasks, such as final testing with federal and state partners, remain to be completed.”
Inside the insurance industry, the assessments were more blunt.
“Everybody seemed to just have an understanding that this thing would not work at launch,” said an insurance industry insider. “Surely that was conveyed to the White House. The idea that anyone could have been surprised or not understand this was way off track would be hard to fathom.”
Insurance industry representatives spoke frequently with administration officials and relayed their concerns with the website, particularly about the transmission of enrollment data to insurers.
“They were told, ‘It’s not a big deal, they’re fixing it,’” one industry source said.
This was the same response health policy experts would receive when they raised any number of issues with administration officials, sources said.
“There was such an environment of don’t do anything that can get bad press,” the insurance industry source said. “That is why nothing was being shared out of CMS. We would share stuff with them. The general viewpoint was — don’t do anything to get any bad press whatsoever. They didn’t create an environment where that would be OK.”
The real issue, White House officials now acknowledge, was that the system was never tested end to end and at a high enough volume.
Immediately after the launch, Obama called the emerging troubles a traffic issue. The administration thought it had one problem, which was essentially that the doorway that allowed people to create an account was too small and only a limited number of people could get through. The small number of people who did get through weren’t experiencing problems, leading the administration to believe that the issues were isolated on the front end.
But once they made adjustments so more people could move deeper into the site, problems were exposed all the way down the line.
Since the launch, Obama has increased the frequency of his meetings with Sebelius, Tavenner and other HHS officials, sometimes calling them to the White House twice a week for briefings. He gets a report every night that details the latest progress on the site overhaul.
The White House maintains that it will meet its self-imposed Nov. 30 deadline to fix HealthCare.gov.
“Our goal is to have that website functioning effectively for the vast majority of Americans by the end of this month,” White House press secretary Jay Carney said Tuesday.
When asked how they could be sure, given the signs they missed the first time around, one official said it was because a different crop of people were in charge now.
But even Obama evinced hesitation in an interview last week with NBC News.
After voicing confidence in the Nov. 30 target, Obama added: “I’ve been burned already with a website — well, more importantly, the American people have been burned by a website that has been dysfunctional.”