The contractors maintained that they fulfilled their own roles in the more than $500 million project but something went wrong with the “integration,” the moment when all the pieces came together. The agency responsible for integrating the work of more than 50 contractors and sub-contractors, five government agencies and hundreds of insurers? The Centers for Medicare and Medicaid Services, which took heavy criticism from Republican lawmakers on the House Energy and Commerce Committee.
Democrats focused most of their ire on the contractors, demanding to know specifically what they plan to do next.
CMS is managing the health care exchange serving the 36 states that asked the federal government to take the lead role in implementing the online marketplaces, the cornerstone of President Barack Obama’s Affordable Care Act. The other 14 states chose to completely manage their own exchanges and have generally faced fewer technical issues than the federal governments’ Healthcare.Gov.
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The federal government never envisioned having to serve that many states but promised that shopping for health insurance—now a requirement in 2014—would be relatively easy. As President Obama put it, buying health care would be like buying "a plane ticket on Kayak or a TV on Amazon." The health exchange website, however, crashed almost immediately after it went live, as consumers found they couldn’t complete the registration process. The contractors called to testify included CGI Federal, the chief website developer; Quality Software Services, Inc., which constructed the infrastructure that allowed access to the federal hub used to verify information from consumers and designed the registration function; Equifax Workforce Solutions, which determines income eligibility; and Serco, which is handling the intake of paper applications.
Questions centered on the roles of CGI and Quality Software Services, which have contracts valued at $293 million and $85 million respectively. Estimates of the total cost of the exchange top $500 million.
Some states, such as Kentucky, allowed for “window shopping” of plans, or anonymous browsing, before registering an account, which tech experts have said helped alleviate problems with volume. CMS refused to allow for a similar feature. Julie Bataille, CMS’ director of communications, defended the agency’s decision to try to make sure every part of the system worked as originally designed instead of trying for a slimmer approach that allowed browsing.
“We made a business decision to prioritize resources so that functionality would be live for consumers Oct. 1,” she said.
Lawmakers repeatedly pressed both Cheryl Campbell, senior vice president of CGI Federal, and Andrew Slavitt, executive vice president for Quality Software Services’ parent company, about testing before the launch. Campbell and Slavitt said testing of the full integrated system didn’t happen until two weeks before the launch, and only CMS had a window into the results.
“We didn’t see the fully kind of integrated end to end testing until a couple of days leading up to the launch,” Slavitt said, adding that “ideally” he should have, given past experiences.
Both Campbell and Slavitt said they’d expect months of integrated testing for projects of a similar scope. Slavitt said he warned CMS about potential pitfalls but never explicitly recommended delaying the launch. Campbell said it wasn’t her place to tell a client what to do.
“It is not our position to tell our client if we should or should not go live,” she said.
Bataille acknowledged that CMS’ testing wasn’t adequate during a conference call after the hearing.
“Obviously due to a compressed timeframe the system wasn’t tested enough,” she said. “I think what’s important to realize is we’re putting in place a much more robust testing system now.”
The contractors said they were confident the system could be completely ironed out in time for all consumers to meet a mid-December cutoff to purchase coverage that starts Jan. 1.
Both the House committees on Energy and Commerce and Ways and Means are scheduled to hold further hearings next week with CMS and Department of Health and Human Services officials. Kathleen Sebelius, secretary of health and human services, is expected to testify.
