Designing Delivery

Introduction

In 1912, Teddy Roosevelt included a proposal for national health care as part of his presidential campaign platform. Nearly 100 years later, in 2010, Congress passed the Affordable Care Act. The legislative process was highly acrimonious. After the law’s passage, the Republican majority in the House of Representatives spent the next three years trying to repeal it. Even now, the law continues to face ongoing legal challenges. The Supreme Court has ruled on its constitutionality once, and likely will be called on to do so again.

The law included two key provisions: citizens could purchase health insurance through state or federal marketplaces, and they would need to buy insurance by the end of 2013 in order to avoid financial penalties. Late in 2013, the government rolled out a website through which people could access the federal marketplace. Its initial release was an unmitigated disaster. The site suffered from pervasive performance and usability problems, security issues, and outages.

Critics immediately blamed a lack of testing. Further exploration, however, uncovered more fundamental issues. Some of those issues were inherent in the nature of government IT procurement. Siloed project management made it difficult for anyone to understand the overall goals or requirements. Various parts of the project were contracted to different vendors. Each vendor worried about its own deliverables. No one took responsibility for integrating the pieces into a working whole. ...