The Third Field

Cases from the record · 2011 – 2013

HealthCare.gov

The warnings were written down. The date did not move.

Before the 2013 launch, the agency building the federal marketplace received repeated written warnings. The inspector general found that delay was never formally discussed.

Process lens Decide → Accept

18documented warnings reached the agency between July 2011 and July 2013 (HHS inspector general)
65%of the marketplace system projected to be ready by September, in a March 2013 estimate (GAO)
Noneformal discussion of delaying the launch, the inspector general found

What happened

The Affordable Care Act required insurance marketplaces to offer coverage from 1 January 2014. The agency responsible set 1 October 2013 for the start of enrollment in the federal marketplace, HealthCare.gov.

The site opened with severe access problems. Later reviews by the Department of Health and Human Services inspector general and the Government Accountability Office found that the risks had been documented for years, and that the launch went ahead without the verification its own rules required.

  1. The contract to build the federal marketplace is awarded.

  2. Eighteen documented warnings reach the agency about leadership, changing requirements and testing.

  3. The agency projects that 65% of the marketplace and 75% of its data hub will be ready by September; a readiness review is moved from March to September.

  4. An outside review flags the risks to senior officials and recommends a single project leader.

  5. A six-month interim authority to operate is signed, with a plan to address open security risks.

  6. Enrollment opens. The site launches with severe access problems.

What the record shows

  1. 01

    The risks were documented.

    The inspector general counted 18 documented warnings over two years. By early 2013 the most common advice was to name a single leader and stop revising policy.

  2. 02

    The warnings did not reach everyone who needed them.

    An outside review went to senior officials; the agency’s technical staff told investigators they did not receive its findings.

  3. 03

    The date was treated as fixed when it was not.

    Some staff believed 1 October was set in law. The law required coverage from 1 January 2014. The inspector general found no formal discussion of delay.

  4. 04

    The launch went ahead without verification.

    The GAO found the agency “launched the FFM system without the required verification that it met performance requirements.” End-to-end testing was never fully completed.

Our reading · Decide → Accept

A decision can look settled while its conditions are still open. When the condition for proceeding is written next to the decision, and the people closest to the work can see it, “we are not ready” becomes a fact on the record rather than a feeling in the hallway.

Context and limits

This account follows the inspector general’s and GAO’s findings. It does not assess the policy, and it avoids the cost and enrollment figures that circulated at the time without a primary source.

From the record to a design question

What must be demonstrated before we proceed, and who is authorized to say that it has been?

What this asks of the process

Keep the decision, unresolved conditions and required evidence together. Separate authorization to proceed from an owner’s acceptance of defined work. An accepted task does not by itself establish launch readiness.

What we do not conclude

Recording a condition does not enforce it. Technical verification, accountable authority and the willingness to change a plan remain necessary.

This is our design inference from the case. The case does not test Sikizana. See the research that informs the sequence

Sources

  1. HHS Office of Inspector General, HealthCare.gov: CMS Management of the Federal Marketplace, OEI-06-14-00350 (February 2016)
  2. U.S. Government Accountability Office, Healthcare.gov: Ineffective Planning and Oversight Practices Underscore the Need for Improved Contract Management, GAO-14-694 (July 2014)
  3. Office of the Assistant Secretary for Planning and Evaluation, Health Insurance Marketplace enrollment report (13 November 2013)
  4. U.S. House Committee on Energy and Commerce, hearing “Security of Healthcare.gov” (19 November 2013)

Based on the linked official record, participants’ accounts and original research. Retrospective accounts and investigations have different limits; they are not controlled tests of a decision method. No organization named here is presented as a customer, partner or endorser of The Third Field.