A Government Accountability Office report on last fall’s HealthCare.gov debacle, released Wednesday in advance of a House Energy and Commerce subcommittee hearing Thursday, details what went wrong. But the bigger questions involve the culture that led administration officials to ignore–and even publicly repudiate–the warning signs that the GAO flagged well before the federal health exchange Web site crashed last October.
Much of the GAO report delves into details of federal contracting policy. But a passage on Pages 3 and 4 illustrates broader problems:
In our June 2013 report on CMS efforts to establish the federal marketplace, we concluded that certain factors–such as the evolving scope of marketplace activities required in each state—suggested the potential for implementation challenges going forward. In comments on a draft of that report, HHS [the Department of Health and Human Services]… expressed its confidence that marketplaces would be open and functioning in every state on October 1, 2013.
The June 2013 GAO report predicted in clear language many of the problems that eventually plagued the federal exchange:
“Much progress has been made, but much remains to be accomplished within a relatively short amount of time,” the report noted. “However, certain factors, such as the still-unknown and evolving scope of the exchange activities CMS will be required to perform in each state, and the large numbers of activities remaining to be performed–some close to the start of enrollment–suggest a potential for implementation challenges going forward. . . . Whether CMS’s contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined.”
Despite these warnings, officials asserted that all was well with Affordable Care Act implementation–until the Web site crashed on Oct. 1.
This week’s GAO report notes that the cost of the contract for a new company to repair the federal exchange nearly doubled–from $91 million to $175 million–over the past six months. The administration explained some of the expense, but the GAO noted that not all of the increase is attributable to the reasons the administration cited. “We continue to believe that a further assessment is needed to ensure that costs as well as requirements are under control and that the development . . . is on track to support the scheduled 2015 enrollment process,” the report said.
Part of effective governance involves adhering to contracting procedures that ensure taxpayers receive value for money and establishing an internal culture that acknowledges faults and in which people work in a transparent manner to resolve them. The GAO report demonstrates how the administration fell short in both respects.
This post was originally published at the Wall Street Journal’s Think Tank blog.