HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Sunday, November 3, 2013

HealthCare.Gov as a Failure of Outsourcing

Media coverage of PPACA over the past week or so has been a mess. Fortunately, a few outlets are investing in technical coverage of HealthCare.Gov by people who actually know what they are talking about. Former programmer David Auerbach has a great series of pieces at Slate about the fiasco. I found this insight particularly important: 

 

[On]ly 30% [of users] have been able to complete an actual insurance application. And that’s not even to say that the application is correct, owing to reports of children getting listed as multiple spouses and the like. . . . [W]hy on earth is the website still up? So people can play insurance-application roulette with 7–3 odds against them? Why not take the site down until it works?
Well, remember how there was very little testing done on the system? It seems that not only was very little testing done, but testing frameworks weren’t set up. That means the team fixing healthcare.gov not only has a lot of bugs to fix, but they don’t have infrastructure in place to identify and reproduce the bugs, which are the first step to fixing them. Under a tight deadline, any such infrastructure will be ad hoc and inadequate. So it’s important that healthcare.gov stays open simply so that potential applicants can run into bugs and report them.

One thing I  plan to do over the next few weeks is to compare the types oftesting of health IT that is required of IT vendors' software (before the providers that buy it can obtain "meaningful use" subsidies for health IT), and the types of testing that CMS did before launching the exchanges. On one level, this is an apples and oranges comparison: software for providing actual care is different than software that is guiding people through a maze of agencies, insurers and data brokers. On the other hand, the testing and certification of health IT involves a multistep process of delegation that has come under some criticism in the past. The larger, common issue is that a federal government that has become so reliant on contractors may be losing its ability to assess the functionality and value of contractors' handiwork.  

On the other hand, an Obama Administration critic contends that the failure may have lain in CMS's refusal to give logs to contractors tasked with debugging.  And only six people registered the first day--a big red flag for anyone in the know. Meanwhile, many state exchanges steam ahead with minimal problems.  And Bill Moyers points out that the Administration asked for more money for the exchange, but was rebuffed by Republicans who want to "end it, not mend it."

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