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Internal Emails Reveal Warnings HealthCare.gov Wasn't Ready

Henry Chao, the project manager of HealthCare.gov, is sworn in to testify before the House Oversight Committee on Wednesday.
J. Scott Applewhite
Henry Chao, the project manager of HealthCare.gov, is sworn in to testify before the House Oversight Committee on Wednesday.

HealthCare.gov could barely function on the day the health insurance marketplace debuted, and internal emails show at least some top health officials could see the failure coming.

In emails from July, released by the House Energy and Commerce Committee, Obama administration officials write of unskilled developers and a series of missed deadlines. One email said the "entire build is in jeopardy." But when the administration's top people in charge of the implementation testified before the committee in the months leading up to the site launch, they said just the opposite — that they were ready.

"Administration officials looked us in the eye and told us everything was 'on track' but when we pull back the curtain now, the mess is disturbing," committee Chairman Fred Upton, R-Mich., said in a statement.

You can read the full email exchanges at the committee site. But here are the most dire warnings detailed in the emails between Henry Chao, the Centers for Medicare and Medicaid Services project manager in charge of HealthCare.gov, and other officials:

  • Three months before launch, only 10 developers from contractor CGI Federal were working on a crucial part of the site — the marketplace for choosing plans — and of those, only one was "at a high enough skill level."
  • Coordination issues between two main contractors — CGI Federal and QSSI. In all, HealthCare.gov has at least 47 different federal contractors involved, but CGI and QSSI won the big contracts for major chunks of the build. It seems QSSI and CGI couldn't seem to work smoothly together. At one point, Centers and Medicare and Medicaid Services' Henry Chao wrote of the contractors, "I just need to feel more confident they are not going to crash the plane at take-off." Today, QSSI is the "lead contractor" in charge of getting everyone on the same page.
  • The only developer who was working on the payment pages for enrollment quit CGI without programming the 10 key user interface pieces of the transaction part. "Needless to say it is in jeopardy," wrote CMS' Jeffrey Grant.
  • The part of the system that does monthly payment calculation of insurance plans did not get priority by the contractor, who called it "not an October 1 item." (The health care insurance website launched Oct. 1.)
  • "Seriously substandard staffing," is how Grant described its contractor's people power. The key contractor, CGI, missed deadlines due to "insufficient" programmer resources. A month from testing certain parts of the system, no development work had even started. CGI Federal got at least $93.7 million to build HealthCare.gov.
  • Interestingly, Chao, who took the brunt of tongue-lashings from lawmakers on the House Oversight Committee this week, comes out in the emails as a decent public servant who took seriously his promises that HealthCare.gov would work, only to wind up the pilot of an exploding plane. With a July email sharing a video link to his summer testimony assuring lawmakers the site would work on time, he urges his team not to fall short, writing:

    " 'I wanted to share this with you so you can see and hear that ... I under oath stated we are going to make Oct. 1,' Chao wrote. 'I would like you (to) put yourself in my shoes standing before Congress, which in essence is standing before the American public, and know that you speak the tongue of not necessarily just past truths but the truth that you will make happen.' "

    The other key takeaway may not surprise those of you who have been following this saga closely. The contractors, namely CGI Federal, were woefully understaffed and underprepared despite their multimillion-dollar federal contract. Its track record with similar IT projects isn't great. The Washington Examiner reported that CGI's performance on Ontario, Canada's health care medical registry for diabetes sufferers was so poor that officials ditched the $46.2 million contract after three years of missed deadlines.

    These documents call into question whether contractors can fix the website as promised by the end of November.

    The HealthCare.gov wreckage highlights the systemic issues with federal IT purchasing: Contractors with serious technical chops often don't compete for these bids. Contractors experienced at navigating the complex world of winning contracts win bids. President Obama reiterated his calls for systemic federal procurement reform in remarks to the press on Thursday.

    Copyright 2021 NPR. To see more, visit https://www.npr.org.

    Elise Hu is a host-at-large based at NPR West in Culver City, Calif. Previously, she explored the future with her video series, Future You with Elise Hu, and served as the founding bureau chief and International Correspondent for NPR's Seoul office. She was based in Seoul for nearly four years, responsible for the network's coverage of both Koreas and Japan, and filed from a dozen countries across Asia.