Correction: We miscalculated the expenditures related to the healthcare exchanges established under the Affordable Care Act, and incorrectly attributed the total cost of these expenditures. We have recalculated the cost to build Healthcare.gov and integral backend systems, and updated the article below to reflect the new information.
It’s been one full week since the flagship technology portion of the Affordable Care Act (Obamacare) went live. And since that time, the befuddled beast that is Healthcare.gov has shutdown, crapped out, stalled, and mis-loaded so consistently that its track record for failure is challenged only by Congress.
The site itself, which apparently underwent major code renovations over the weekend, still rejects user logins, fails to load drop-down menus and other crucial components for users that successfully gain entrance, and otherwise prevents uninsured Americans in the 36 states it serves from purchasing healthcare at competitive rates – Healthcare.gov’s primary purpose. The site is so busted that, as of a couple days ago, the number of people that successfully purchased healthcare through it was in the “single digits,” according to the Washington Post.
We, the taxpayers, seem to have forked up more than $500 million of the federal purse to build the digital equivalent of a rock.
The reason for this nationwide headache apparently stems from poorly written code, which buckled under the heavy influx of traffic that its engineers and administrators should have seen coming. But the fact that Healthcare.gov can’t do the one job it was built to do isn’t the most infuriating part of this debacle – it’s that we, the taxpayers, seem to have forked up more than $500 million of the federal purse to build the digital equivalent of a rock.
The exact cost to build Healthcare.gov and its related systems is difficult to determine due to the expansive nature of the project and the murky details in federal budgets. But based on the figures and details available, here is my best estimate of what this flawed system has cost us: The most clear data comes from a U.S. Government Accountability Office (GAO) report from June (pdf), which states that the U.S. Center for Medicare and Medicaid Services (CMS) spent “almost $394 million from fiscal year 2010 through March 2013 through contracts” to build the “federally facilitated exchanges” (FFEs) – the complex system that includes Healthcare.gov as well as certain state-based exchanges – the data hub, and other expenditures related to the Obamacare exchange system. While GAO states that the “highest volume” of that $394 million was related to the development of “information technology systems,” a more detailed look at that cost shows that a portion that $394 million was spent on things like call centers and collection services. Take that out, and you’re left with roughly $363 million spent on technology-related costs to the healthcare exchanges – the bulk of which ($88 million) went to CGI Federal, the company awarded a $93.7 million contract to build Healthcare.gov and other technology portions of the FFEs.
That’s already a hell of a lot of money, but that does not account for all costs accrued for this project. As the GAO states, the $392 million figure does “not include CMS salaries and other administrative costs” associated with the Obamacare exchanges. In other words, the actual cost for the development and implementation of the total Obamacare exchange system is far higher. We’ve reached out to CMS for an exact figure, but thanks to the government shutdown, we have yet to hear from them on this matter. However, we do know, according to CMS’s 2014 budget request (pdf), that agency spent more than $150 million in 2012 and 2013 in relation to the Affordable Care Act – a lowball figure considering that, in its 2013 budget request (pdf), the agency asked for more than $1 billion in additional funds “needed to support operation infrastructure” and open-enrollment preparations of the FFEs.
At this point I can only speculate on the total cost to build out Healthcare.gov and the overall technology portion of the FFEs. Based on the available data, however, a conservative estimate puts the cost so far at over $500 million. Considering the GAO estimates it will cost approximately $2 billion to build-out and operate the FFEs in 2014, this is, if anything, likely far too low. Once we hear back from CMS on this matter, I’ll update this space with more detailed figures above the $363 million we know about for certain.
Given the complicated nature of federal contracts, it’s difficult to make a direct comparison between the cost to develop Healthcare.gov and the amount of money spent building private online businesses. But for the sake of putting the monstrous amount of money into perspective, here are a few figures to chew on: Facebook, which received its first investment in June 2004, operated for a full six years before surpassing the $500 million mark in June 2010. Twitter, created in 2006, managed to get by with only $360.17 million in total funding until a $400 million boost in 2011. Instagram ginned up just $57.5 million in funding before Facebook bought it for (a staggering) $1 billion last year. And LinkedIn and Spotify, meanwhile, have only raised, respectively, $200 million and $288 million.
Government has a long history of spending money unnecessarily. But in an age when the U.S is home to the world’s largest, most successful Internet companies, how is it possible that we can’t even manage to build a functional website without blowing through hundreds of millions of dollars?
The best answer I’ve found comes from the Department of Better Technology, a private company that builds software for governments – a competitor, in other words, to CGI Federal, which specializes in building software solutions for major industry sectors including defense, energy and environment, financial and, of course, healthcare. Still, biased though it may be, the argument makes a lot of sense.
As one of the company’s authors wrote in a recent blog post, the failure of Healthcare.gov isn’t because the people in our government are inept mouth-breathers who regard the work as a meaningless burden, but because the factors that play into which companies receive government contracts, a process called “procurement,” are fundamentally broken.
“Contracting officers – people inside of the government in charge of selecting who gets to do what work – are afraid of their buys being contested by people who didn’t get selected,” writes the author. “They’re also afraid of things going wrong down the line inside of a procurement, so they select vendors with a lot of ‘federal experience’ to do the work.”
When things still go wrong, they simply throw ‘more money at the same people who caused the problem to fix the problem.’
And when things still go wrong, they simply throw “more money at the same people who caused the problem to fix the problem.”
Considering the frustrating bunch we have in Congress at the moment, this assessment seems particularly believable.
Unlike some Americans, I actually want the Obamacare exchanges to succeed. I’ve given the state-specific options a try (there are 15 of them, including Washington D.C.’s) and they seem to greatly simplify the process of buying healthcare. And the rates do appear to come in far lower than what many people without health insurance from an employer have had to bear until now. It’s not government-run healthcare. There are no death panels. And, from what I can tell, the world will not end if more people have health insurance – quite the opposite, in fact.
What I cannot stand is a nation that has vast technological resources in its citizenry spending $500 million of our collective money to slap together a product that, thus far, has only managed to waste people’s precious minutes. So the next time our government comes up with any bright idea that relies upon a massive website, let’s all be sure to ask how they plan to build it. Because the standard operating procedure at the moment is just plain sick.