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Table of Contents
Executive Summary....................................................................................................................... 3Issues ......................................................................................................................................................... 3Findings .................................................................................................................................................... 3Recommendations ................................................................................................................................... 4
Purpose ........................................................................................................................................... 5Overview ......................................................................................................................................... 5Analysis ......................................................................................................................................... 11Public Administration Issues ...................................................................................................... 18Recommendations........................................................................................................................ 20References .................................................................................................................................... 25
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! The federal Department of Health and Human Services was tasked with developing andimplementing the Affordable Care Act website to allow consumers to enroll in insuredhealth plans by a strict deadline of October 1.
! The launch of the website was unsuccessful due to insufficient time to fully develop asite, a lack of user experience testing, incomplete guidelines for operations, theunanticipated large number of applicants applying for healthcare, and the decision to usemultiple contractors with different responsibilities to create the site.
! Americans will have to pay a tax penalty if they are unable to enroll in a plan by January1, 2014.
! An overarching explanation for the failure of the federal healthcare web portal is due to alack of centralized planning and coordination among the various contractors involved in
the development of the site and the absence of a strong body of oversight andaccountability.
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! The HHS is facing challenges in a lack of centralized planning and coordination,contracting, political tension, and leadership.
! The main contract to build the federal healthcare portal was awarded to a Canadian firm,CGI Federal Inc., but CGI Federal subcontracted with other large firms for differentcomponents of the site. Roughly 12 to 15 companies were working on the site, but therewas little to no planning and coordination between the various parts of the portal todetermine and understand bugs in the system, coding issues, and massive glitches.
! Quality assurance of the site was deterred due to the unwillingness to share informationand communicate concerns, which lead to the improper delegation of responsibilities andaccountability of duties.
! The Obama administration created a sense of urgency to meet deadlines and produce aproduct due to Republican opposition against the ACA. The influence of politics indecision-making increased the likelihood for failure.
! There are stark similarities between the implementation of the ACA website and thelaunch of the Columbia shuttle in 2003 that can help provide historical insight to preventproblems from occurring again.
! Had the HHS adopted an incremental approach to make small changes to the site beforereleasing it to the public, the consequences could have been more predictable and lessproblematic.
! Tensions between administration and power, administration and politics, andadministration and competing public values could have been loosened had the HHS beengiven clear goals by electoral institutions, provided adequate resources, and givenautonomy to apply their expertise to the problem.
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9)*:44)%8&1":%7
Recommendations for the HHS as it moves forward with the federal healthcare portal:
1. Appoint a middle manager to communicate to the Obama administration any issues withthe site as they are occurring.
2. Recruit a chief risk officer who can serve as the node that communicates between thedepartments and contractors involved in developing the site to the middle manager.
3. Cultivate an environment that supports open communication, so that all issues that ariseare heard and documented.
4. Practice inclusive management, so that all different perspectives are involved in theprocess for decision-making and problem solving.
5. Act as self-stewards in the field to actively advocate for a voice in determining resourcesand making decisions.
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federal control on healthcare ("History of the Passage of the March 2010 Health Care Reform
Laws," 2011). Ultimately, the House of Representatives passed a version of the bill by a vote of
220-215, while the Senate passed its version of the bill with a vote of 60-39 (Smith, 2012).
Democratic President Barack Obama signed the bill into law with no Republicans supporting the
bill, and a separate bill was created to ensure support in the House of Representatives (Henry et
al., 2010). The ACA was created to offer reforms that improved access to affordable health
coverage for every American and protect consumers from abusive insurance company practices
("Health Care that Works for Americans," 2013). The intent of the ACA was for consumers to
feel a sense of empowerment in regards to their healthcare coverage by giving them stability,
flexibility, and information to make educated choices about their health (HHS, 2013b).
The stakeholders involved and impacted by the ACA federal portal site include federal
employees at the HHS, contractors, the Obama administration, members of Congress, the general
public, and state governments. The general public has a large stake in this issue because if
Americans are not enrolled in insurance that qualifies as minimum essential coverage, then they
are required to pay a penalty fee (HHS, 2013e). Paying the penalty fee offers absolutely no
health insurance coverage and individuals without minimum essential coverage are responsible
for all of the costs of medical care (HHS, 2013e). State governments also play a role in the
development of the site, and have contributed to the unanticipated large number of requests on
the first day of site implementation. There are 36 states that rely on the federal healthcare portal
to navigate accurate information and enroll in a health plan, because these 36 states did not
develop their own portal. With more states relying on the federal portal, the number of users
increases and the site becomes more complex to handle the large number of people enrolling.
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The Secretary of HHS, Kathleen Sebelius, is responsible for all new programs created by
the ACA, which has included establishing and implementing a health insurance web portal
(HHS, 2013c). The goals of the ACA include expanding affordability, quality, and availability of
private and public health insurance by way of consumer protections, regulations, subsidies,
taxes, insurance exchanges and other reforms ("ObamaCare Facts," 2013). The ACA website,
www.healthcare.gov, was envisioned to provide greater access to healthcare, which is one of the
key features of the ACA. The ACA website provides a medium for learning about private health
plans, getting answers to questions about health coverage options, obtaining possible cost
reductions for healthcare, and enrolling in a health plan that fits the consumers needs (HHS,
2013d). However, the launch of the website on October 1, 2013 failed to provide an effective
system that would allow consumers to enroll in health plans.
The launch of the federal healthcare portal failed for a number of reasons. Since the
passage of the ACA in 2010, the development of the website was under a tight deadline. Within
a six-month time frame, Federal officials were supposed to ensure that all insurers filed
applications describing the benefits and costs of the products for consumption while meeting
compliance with federal regulations, establish a telephone call center to help consumers, certify
health plans approved for sale to the public, and guarantee implementation of a functional portal
for consumers to enroll in health plans (Pear, 2013). Due to the time sensitive deadline,
developers admit there was a lack of testing to analyze the user experience for the site in its
entirety. Contractors expressed concern over the impending launch date to a congressional
committee, because the site needed several months to fully test such a complex system (Pugh,
2013). In addition, government reports have suggested that the Obama administration further
delayed the process for testing due to incomplete guidelines for the portal operations (Pugh,
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2013). Another possible reason for why the portal was unable to support submissions for
enrollment was due to the large number of users applying on October 1, the first day the portal
was open for applications. Federal officials severely underestimated the large number of users
that applied on the first day. The portal was designed to support 50,000 to 60,000 concurrent
users, but over 250,000 users flooded the site on October 1 (Begley, 2013).
An overarching explanation for the failure of the federal healthcare web portal that may
also serve as the root of the problems enumerated in the preceding paragraph is due to a lack of
centralized planning and coordination among the various contractors involved in the
development of the site and the absence of a strong body of oversight and accountability. A large
sum of money was granted for the project, but Sebelius was not allocated funding for the
purposes of hiring an individual or a team of people to develop the federal healthcare portal
directly under her (Mead, 2013). Any attempts to allocate funding hire an individual or a team
for oversight and accountability purposes was blocked by the Republican party (Mead, 2013). As
a result, the design of the federal healthcare portal was fragmented.
The fragmentation may also stem from the inadequate delegation and coordination of
responsibilities and duties between the various contractors. The main contract to build the federal
healthcare portal was awarded to a Canadian firm, CGI Federal Inc., but CGI Federal
subcontracted with other large firms for different components of the site (Jeffries, 2013).
Roughly 12 to 15 companies were working on the site, but there was little to no planning and
coordination between the various parts of the portal to determine and understand bugs in the
system, coding issues, and massive glitches (Jeffries, 2013). Due to procurement regulations,
federal contracts are often awarded to the lowest bidder. Awarding the lowest bidder does not
offer strong incentives to deliver the best performance. In addition, other rules and regulations
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limit the strongest candidates to produce the site. For example, contractors on federal projects are
often required to have the Federal Information Security Management Act certification, but many
smaller companies lack this certification (Jeffries, 2013). Hiring smaller firms diversifies the
workforce and may bring more innovative sensibility to the project which could have helped
with the overall rollout of the site (Jeffries, 2013).
Frequent, last minute changes were often requested leading up to the launch of the site.
This caused complications for developers within each project scope. One change that seemed to
cause issues with the site was the decision to require all consumers to register for an account
prior to viewing the different insurance packages. Making a change requires clear
communication between the developers, reliable coding within all aspects of the site, and testing
to the consumers, but deadlines often hindered progress on these quality assurance parameters.
Quality assurance was also deterred due to the unwillingness to share information and
communicate concerns, which led to the improper delegation of responsibilities and
accountability of duties. Directors of the HHS throughout the years after March 2010 reported
that the portal was following the projected timeline for the launch, but did not show data that
supported such statements (Goldstein & Eilperin, 2013). On the one end, developers were aware
of the issues, but suppressed concerns because of the power dynamics that limited their ability to
push back or question authority at the Obama administration (Goldstein & Eilperin, 2013). On
the other end, policymakers in the Obama administration had the power to push for (or extend)
deadlines, but these individuals did not have expertise in managing a critical operating path
design and programming the system (Goldstein & Eilperin, 2013)
The Obama administration created a sense of urgency to meet deadlines and produce a
product due to Republican opposition against the ACA. The Obama administration did not want
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to provide more fodder for the Republican Party to dislike the policy especially since the passage
of the act endured long, political battles. The fear infused by the Republican Party was effective
in infiltrating the decisions and policy processes made by the Obama administration.
Originally, the Office of the Secretary of Health and Human Services was responsible for
designing and constructing the health insurance portal, but the office did not have the resources
to fulfill all of the obligations in producing a functional site such as awarding grants and outside
contracts (Goldstein & Eilperin, 2013). Thus, the office changed its name to the Center for
Consumer Information and Insurance Oversight and moved into a larger agency, the Centers for
Medicare and Medicaid Services (CMS) in 2011. While the move reflected the need to have
access to greater resources, there was also a political underpinning that would help limit
Republican influence (Goldstein & Eilperin, 2013). Some administration officials believed the
move would help the Center for Consumer Information and Insurance Oversight retain and
secure funding because it was within the large bureaucracy of the CMS. House Republicans
would have more difficulties reducing or eliminating funding from a larger organization like the
Center for Consumer Information and Insurance Oversight. In many circumstances, the influence
of politics in decision-making increased the likelihood for failure.
There are public administration and democracy tensions that have prevented HHS
administrators from fully completing the task of developing the federal healthcare portal.
According to Waldo, democracy is expected to promote equity, dignity, inclusiveness and
accountability (Waldo, 1948), while Meier describes bureaucracies as the implementation of
policies, government programs, and enforcing the rule of law (Meier, 1997). This leads to a
tension between power and administration, where the HHS is expected to carry out a health care
policy that promotes equity, but struggles to do so because of the influence of politics. Relatedly,
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the tensions between politics and administration are evident since the legislation was proposed to
current day. Furthermore, the tensions of balancing competing democratic and administrative
values are also challenged in this issue.
?%&-57"7The poor planning and coordination of the implementation of the federal healthcare portal
has adversely impacted the HHS and the Obama administration in how the public trusts the U.S.
governments leadership and competency. Public trust in leadership and competency are
important for the future of the federal healthcare portal. The HHS has faced and is facing
challenges in a lack of centralized planning and coordination, contracting, political tension, and
leadership. The HHS and the Obama administration have openly apologized to the public about
the failures of the site, and have promised to resolve the issue as soon as possible. There are stark
similarities between the implementation of the ACA website and the launch of the Columbia
shuttle in 2003 that can help provide historical insight to prevent problems from occurring again.
Once the ACA was signed into legislation, Obama made clear that the seamless execution
of the federal healthcare portal was the top priority. However, Obama was unaware of the grave
issues throughout the process, and ultimately unable to ensure that the site met all of the goals
and objectives. While Obama had congressional experience as the state senator of Illinois, he had
no management experience in orchestrating a large bureaucracy and garnering bipartisan support.
Obama succeeded in the first portion of Richard Nixons definition of leadership in establishing
a vision and defining his agenda, but Obama failed to perform the second criteria effectively in
building interpersonal transactions to bring about his most important goals (Heifetz & Sinder,
1990). Governorship experience could have helped Obama gain expertise in improvisational
flexibility and insight to direct others like Sebelius in determining what objectives needed to be
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met in a complex project like the roll out of the federal healthcare portal (Heifetz & Sinder,
1990).
While in theory, President Obama seemed to be at the top of the bureaucratic structure
with Sebelius considered right beneath him in terms of chain of command. However, the
structure seemed to be more flat with the large number of contractors working on the project, and
no single leader was responsible for executing the site comprehensively. The lack of funding and
imprudent use of funding limited Sebelius ability to oversee the entire operation or hire a team
tasked with ensuring quality checks throughout the process. The existence of a bureaucratic
structure with a clear leader for the development of the federal healthcare portal can ensure that
there is a firmly ordered system in place between superiors and subordinates where superiors can
supervise lower offices (Weber, 2010). However, open communication and collaboration
between the various offices in the HHS is critical in ensuring that all components of the site are
functioning together, which is not necessarily a component of bureaucracy.
The development of a complex site like the federal healthcare portal requires millions of
lines of coding, time, support, and opportunities to address coding and database obstacles. The
complexity becomes more perplexing when over a dozen contractors are working on different
components of the site. The idea of employing multiple contractors simultaneously on the project
could speed up the development. However, the reality is that the project suffers because
components of a software application should often be developed in succession to work properly
(Pear, Lafraniere, & Austen, 2013).
Contracting out is a strategy for government entities to accomplish complex tasks when
expertise does not exist within the government (Stillman, 2010b). The premise of contracting out
is attractive because an expert body can perform more efficiently and effectively by completing a
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larger number of complicated tasks within a shorter time frame (Stillman, 2010b). Nearly 60
percent of goods and services produced by the federal government is through contractors, and
this is indicative of a shift to appease the public to shrink the size of government without actually
adding contractors to the federal payroll (Stillman, 2010b). Thus, politicians are able to serve
constituents effectively through competent personnel that meet the standards of the contract
proposal, while leading the perception that the size of government has stayed the same or has not
increased.
While contracting out may seem beneficial for efficiency and cost purposes, there are
disadvantages as evidenced by the issues surfaced from the execution of the site. One of the
problems in contracting out is that there can be difficulties in determining where government
bureaucracy begins and ends, and defining whether internal government workers or the
contractors are at fault for problems that arise. For instance, contractors hired to design the
federal healthcare portal have blamed the federal government for the lack of oversight,
pressuring unrealistic timelines, and fluctuating requests and demands. On the other hand,
employees at HHS have expressed frustration with the contractors in that the contractors have
failed to be transparent in the issues that have occurred and giving misleading assertions that the
site would be completed in time.
The federal procurement process to hire contractors typically requires selecting the
proposal with the lowest bid or the bid with the best value. However, this process does not
always equate to hiring contractors that are motivated to perform above and beyond. For the
federal healthcare portal, CGI Federal was suspected to be the only company considered to
receive the largest contract to work on the rollout (Pollock, 2013). CGI Federal had a history of
delivering services and products for hardware, software, and communication since 2007, and
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went through the ID/IQ process to acquire the contract (Pollock, 2013). ID/IQ is defined as
Indefinite Delivery and Indefinite Quantity, which helped CGI Federal become a noticeable
candidate for various awards without requiring public notice or undergoing the standard
competitive bidding process. The ID/IQ process is streamlined so that contracts are approved
faster, but this process may hinder the quality of work when there is no competitive bidding
(Gore, 2013). Ultimately, $394 million was spent on contracts to develop and implement the
federal healthcare portal, but the short timeframe, lack of oversight, and the complexity of
coordinating multiple contractors with different tasks to develop an intricate site intensified the
problem for both the contractors and the HHS administrators (CBS, 2013).
The project lacked sufficient planning and coordination among all the stakeholders
involved. One aspect that was not given realistic planning was time. CGI Federal was awarded a
multimillion-dollar contract in December 2011, but they could not start the process until months
later because the government was slow in determining specifications. While it is understandable
that the administration wanted to get the process going since the issue was in the forefront of
policy issues, a person or team in a position of leadership, authority, and power should have set
reasonable deadlines for the functional specifications.
Another factor that impacted the planning and coordination of the site was due to the
decision-making process. The HHS and Sebelius could have benefited in the branch decision-
making approach prior to the official public release of the site. While the site was a project that
had been in the works for years, the process was typical of many federally funded software
projects. Federally funded software projects have a project plan that entails exactly what the
software is intended to do, the cost, how the site will look and specific timelines of when the
project will be accomplished (Hen, 2013). This process leaves little room to develop each part of
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the site while also measuring and evaluating how the system will function before moving onto
the next part. The culture of the project did not welcome small failures that allowed for
reflection. Instead, the process employed lead to one large problem.
Charles Lindblom would likely describe the execution of the federal healthcare portal as
unusual, because the decision-making process did not occur as a successive limited comparisons
or branch method. The branch method approach is typical of administrative decision-making as
opposed to the root method (Stillman, 2010a). The branch method is described as an incremental
approach where small steps are taken to achieve objectives, and not broad leaps and bounds
(Stillman, 2010a). The advantage of the branch method is that small incremental changes allow
decision makers to avoid making serious lasting mistakes (Stillman, 2010a). Furthermore, the
branch method would have made more sense due to the nature of website development. Website
development requires frequent testing and sequential steps to produce a comprehensive site.
Because of budgets and legal constraints, the development of the site had to meet the contractual
obligations of the initial commitments of what the site would look like even if the technology
changed or if different services were needed. Had the HHS adopted an incremental approach to
make small changes to the site before releasing it to the public, the consequences could have
been more predictable and less problematic (Stillman, 2010a).
On the other hand, the HHS was under time constraints to roll out a service, whether or
not the service was completely ready. In their view, the site may not have been optimal, but
functional enough. In this case, the HHS is an example of Herbert Simons theory of satisficing,
where the HHS had no way of identifying and developing the best models of the sites especially
under the time constraints (Simon, 1997).
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The time constraints were mainly triggered by the Obama administration to produce a
functional site within the established deadline, so that the Republican Party would not have
another reason to ridicule and criticize the ACA. In addition, the Obama administration desired
fast results with efficient use of resources so that the Republican would not further believe that
the ACA was a costly example of government intrusion. However, political influences largely
impacted the policymaking and implementation process. For example, senior health advisors
developed diagrams to the states to explain concepts of operations, which would show how the
federal healthcare portal would look like. The Obama administration was hesitant to use the
diagrams in fear of presenting a diagram that may seem too perplexing, and further leading the
Republican Party to believe that the ACA was too complex for states to understand (Goldstein &
Eilperin, 2013). As stated earlier, the decision to move and rename the office responsible for
producing the site had political underpinnings as well. The Obama administration displayed
concern over Republican reaction in fear of reduced or blocked funding initiated or supported by
the Republican Party.
There are stark similarities between the launch of the Columbia shuttle by NASA in 2003
and the rollout of the federal healthcare portal. The Columbia shuttle disintegrated during the
return portion of the flight and resulted in the deaths of seven members of the crew (Casamayou,
2010). In both instances, technology was initially blamed and could easily be used as the reason
for the failure. However, both problems were grounded in external forces that shaped higher-
management perceptions of risk (Casamayou, 2010). NASA and the HHS were pressured to
respond to the White House, Congress, and the public. One of NASAs officials vocalized that
NASAs budget was underfunded to meet the obligations established by the project plan, but
funding remained flat throughout the course of the project. The officials recommendation went
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unheard, just as several HHS analysts request for more resources like funding and time went
unheard. In addition, NASA was driven by values to launch the Columbia shuttle faster, better,
cheaper (Casamayou, 2010). In the same sentiment, the HHS valued rolling out the federal
healthcare portal through best value contracts and ensuring that the site was completed despite
a limited time frame to fully produce a well developed site. Both situations had an overly
ambitious schedule and an organizational environment that supported getting the job done as
opposed to getting the job done well. Professor Casamayou assessed the Columbia accident and
has described several suggestions to prevent NASA and the HHS from experiencing similar
problems in the future. She suggests that agencies should be committed and dedicated to the
mission and objectives of the agency and not the political pressures that may drive key decisions
(Casamayou, 2010). She also recommends that the agencies establish realistic timelines with
sufficient resources to fully fulfill all the obligations at hand (Casamayou, 2010). In addition, a
leader needs to be in place to support an environment that values risk aversion (Casamayou,
2010). Lastly, the inclusion of centralized management can enhance communication and control
over the various departments (Casamayou, 2010).
After the rollout of the federal healthcare portal, officials have taken some steps that
resemble the recommendations offered by Casamayou. Obama has openly addressed issues
surrounding the federal healthcare portal and has publicly apologized for the failure of its
intended purpose. Sebelius has also issued public announcements apologizing for the failure of
the site and has testified before the House Energy and Commerce Committee in an effort to
explain what went wrong. Sebelius has requested the inspector general to investigate issues with
the contracting process, management, performance and payment issues (Sebelius, 2013).
Sebelius has also seemed to take responsibility for the failure of the site, and has remarked I
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believe strongly in the need for accountability, and the importance of being good stewards of
taxpayer dollars (Sebelius, 2013). Both Obama and Sebelius have mentioned that they have
recruited the best and the brightest from both the private and public sectors to help fix bugs
and glitches and ensure better user experience (CBS, 2013). Other reforms include addressing
risks as they occur, conducting daily tests of the site, monitoring the site for security issues, and
applying a full security test from beginning to end (Kennedy & Cami, 2013). In addition,
Sebelius has ordered the establishment of a new position called the chief risk officer at the
CMS to oversee new programs created to expand health insurance coverage (CBS, 2013). The
chief risk officer is expected to ensure that all technology programs work as publicized (CBS,
2013). Reforms will also be made in how outside contracting is conducted, which will include
retraining for best practices (CBS, 2013).
;0@-"* ?84"%"71#&1":% 6770)7The development, execution and management of the federal healthcare portal exemplify
the various tensions that exist between democracy and administration. The tension between
power and administration is evident. As Long argues, administrative institutions must compete
for limited power resources from clientele and constituent groups, legislative and executive
branches, and the general public to maintain a viable organization (Stillman, 2010c). In the case
of HHS, the agency not only had to compete for funding resources from Congress and acquire
technical expertise and administrative aid from the Obama administration, but also maintain
relationships with the public. The HHS is situated under the executive branch, receives funding
from Congress, and strives to help the public as enumerated by their mission statement, goals,
and objectives. Thus, the HHS is expected to respond to various groups, but the establishment of
determining which groups to prioritize first and foremost is difficult. Obama is an elected official
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administration was described as the accomplishment of planning, organizing, staffing, directing,
coordinating, reporting, and budgeting when it was first characterized, and the HHS had all of
these responsibilities to carry out when executing the federal healthcare portal (Stillman, 2010d).
At the same time, HHS was also expected to perform these tasks efficiently and effectively to
serve the public. As mentioned earlier, one of the reasons HHS chose CGI Federal as a
contractor was due to the streamlined process to expedite the contract process. However, this
process limited the opportunities for other contractors to competitively bid and hindered
opportunities for diverse firms to be involved for the sake of efficiency.
Ultimately, tensions between administration and power, administration and politics, and
administration and competing public values can be loosened when agencies are given clear goals
by electoral institutions, provided adequate resources, and are given autonomy to apply their
expertise to the problem (Meier, 1997). The HHS may have seen fewer failures had they
followed Meiers recommendations to allocate sufficient resources like funding and time and
allowed the developers to design a site without political influences.
9)*:44)%8&1":%7As the HHS is recovering from the failure of the initial rollout of the federal healthcare
portal, there are several recommendations that the HHS can consider to improve the process and
prevent issues in the future. First, the HHS should appoint a middle manager to communicate to
Obama any issues with the site as they are occurring. Second, the addition of a chief risk
officer can serve as the node that communicates between the departments and contractors
involved in developing the site to the middle manager. Third, cultivating an environment that
supports open communication is essential so that all issues that arise are heard and documented.
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Fourth, the chief risk officer and his team can play a large role in practicing inclusive
management, so that different perspectives are involved in the process for decision-making and
problem solving. Fifth, the HHS should be stewards in the field to actively advocate for a voice
in determining resources and making decisions.
In order for Obama to have a thorough understanding of critical setbacks of the site as
they are occurring, he needs to have a middle manager. Sebelius has the authority to fulfill this
capacity to mobilize the resources of the group (superiors, subordinates, lateral colleagues, the
press, outside parties) to do work (come to terms with problematic situations), then the task will
generally consist of capturing and directing attention to the problem, containing the stress and
frustration that inevitably come from facing tough situations, corralling the various constituents
into working relationship with one another, and managing that work process (defining, refining,
and resolving problems) over time (Heifetz & Sinder, 1990). Obama can strengthen his
leadership by introducing a role with these traits, so that there are open and transparent lines of
communication. Sebelius can serve as the node to relay information from developers and
contractors who are experiencing issues with the site directly to Obama, so that he is well aware
of the issues and can recommend extending deadlines or offering additional support.
The addition of a chief risk officer is a wise decision if implemented correctly. This
role can serve as the facilitator within the HHS to convey issues to Sebelius, and Sebelius can
relay this information to Obama. The recruit for this position should have expertise in both
technical aspects as well as managerial skills. This person should have a thorough understanding
of the development of the site as well as the capacity to manage different groups to produce a
complex site. The chief risk officer should also have an internal team that can help supervise all
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of the various contractors and serve as a source of facilitating communication between the
contractors to determine if the site is planned and coordinated amongst all groups.
Another way to improve the current project management of the federal healthcare portal
is to provide a forum that is open to hearing the opinions of experts in the field. There were
respected, knowledgeable people who came to the Obama administration fully aware of the
potential difficulties and challenges of the development of the federal health insurance portal, but
no one seemed to listen. The director of the White Houses National Economic Council, Larry
Summers, and the head of the Office of Management and Budget, Peter Orszag, were informed
by a health advisor that no one in the administration was fully capable of overseeing the
development of the portal and fully interpreting and implementing all of the elements of the
ACA legislation into actuality (Goldstein & Eilperin, 2013). Obamas economic and healthcare
advisers strongly encouraged the appointment of an outside health reform expert in business,
insurance, and technology, but other advisers argued that the existing health aides who saw the
legislation from birth to infancy were well equipped to perform the task (Goldstein & Eilperin,
2013). There have been other instances where experts have spoken to the administration about
the unrealistic goals of producing a site by the set deadline, but their voices were left unheard.
From this point forward, if several experts communicate issues about the site, it is imperative
that leadership considers these implications instead of letting the problems fall by the wayside,
which will ultimately lead issues in the future.
Ultimately, the practice of inclusive management should be applied as the federal
healthcare portal is refining its systemic processes. Inclusive management involves combining
information and perspectives from the political, the technical, and the experiential, so that
perspectives from different communities can use their expertise to address public problems
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(Feldman & Khademian, 2007). While there are some analyses that find bureaucracy as a threat
to democracy (Kaufman, 2001), the premise of inclusive management is fundamental to
democracy (Feldman & Khademian, 2007). One of the issues surrounding the rollout of the
federal healthcare portal was that elected officials and political appointees were responsible for
conducting the processes to hire qualified contractors and overseeing their progress, but these
officials did not have expertise in website development. On the other hand, developers as federal
employees and contractors may not have understand the relevance of their role as a public
servant to produce a site that is used for the public good, and not for profit. The appointment of a
chief risk officer can engage different perspectives, so that each department or group has a
thorough understanding of their role within the larger picture. In addition, inclusive management
can help ensure that information and data is distributed to all departments, so that no one
contractor is responsible for resolving a particular issue. For instance, an organization operating
under inclusive management enables different departments to understand issues that are not
typically within their scope of work. Contractors who are struggling to understand issues with
coding glitches in one component of the federal healthcare portal can receive help from other
contractors who have experienced similar issues.
Furthermore, agencies like the HHS should not allow decisions to be made that will
impact how their work is conducted when they have no voice in the matter. Following
Goodsells suggestion, the HHS should be actively involved in dealing with large policy
decisions. The HHS can break free from political pressures by being administrative self-
stewards. Self-stewardship can allow agencies like the HHS to advocate for policies that protect
the foundational aims and goals of the agency. As the U.S. continues to experience economic
woes, budget cuts are likely to occur. To ensure that the HHS is provided with sufficient
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resources, administrators must demand spending reductions that are minimally damaging
(Goodsell). In addition, HHS administrators should define the essence of the mission as clearly
as possible, and spend leanly so that funds are only directed towards the mission. As discussed
earlier, another component of Goodsells aims for self-stewardship include open communication.
With numerous stakeholders involved in the process of rolling out the federal healthcare portal, it
is essential that all strategic points of an organizations environment have opportunities to
communicate (Goodsell). Open communication helps build trust, and when issues arise, the
problem is shard amongst all stakeholders.
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