Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
You may be surprised to learn that when you arrive at HealthCare.Gov the first page you see on the Web site was not built in a bland office park somewhere in Virginia. It was built in the District of Columbia. By a team of 12 engineers. Their offices are in a garage, and they wanted to use the site to buy themselves health insurance in 2014.
Before large contractors took over, a small firm called Development Seed laid much of the groundwork for the site that millions of Americans are trying to access today. It spent four months, starting in March, as a government sub-contractor, building the version of HealthCare.Gov that launched in June. Their work remains the home page of the newly launched Web site.
Development Seed is by no means the entire force behind the massive Web site. A bigger company, CGI Federal, developed the back-end functions where people create accounts and find out if they're eligible for coverage. CGI has declined requests for comment.
I did, however, get a chance to chat with Development Seed president Eric Gundersen about the issues with access to HealthCare.Gov. "This is not the launch I expected," Gundersen said. "I expected I would be able to register and get health insurance." I asked Gundersen to help explain how HealthCare.Gov is supposed to work and what the current problems are.
There are two big parts of HealthCare.Gov, built by different contractors.
This is a point that David Auerbach has made over at Slate and one that Gundersen went through in detail. Development Seed built the front end of HealthCare.Gov, the Web site you see when you go to HealthCare.Gov, and also the resources behind the "Start Here" button.
"Our main contribution is the home page," Gundersen said. "That's the stuff we released in June and scaled throughout the summer and through last week, as more people were coming to sign up and the home page was getting more traffic."
Development Seed and CGI used different technology to power their parts of the site. That means that clicking on different buttons - "Apply Now" versus "Start Here" - will take you to vast sites that essentially speak different languages.
The application section has had much more trouble handling the high volume of traffic than has the home page, although it's also doing some heavy lifting by sending tons of information between federal agencies.
The two parts of HealthCare.Gov don't talk to each other very much.
Development Seed finished its work this summer. It then handed off its files to CGI Federal, which received a contract from the Department of Health and Human Services back in December 2011 to work on the federal marketplace. The two firms have not communicated since. The federal government has Development Seed signed up for an additional 100 hours of work but, since the Oct. 1 launch, the firm hasn't been asked to do anything.
Development Seed never bid to build the back end of HealthCare.Gov because it didn't believe it had the legal team to go through the procurement process. The firm's first contract happened largely by happenstance: Obama administration officials had been reading the agency's blog, liked what they saw and asked the team to come onboard.
Even then, Development Seed wasn't working directly with the federal government. It got involved as a subcontractor to a larger firm called Aquilent, which declined to comment for this report. A spokeswoman said that Aquilent was "not authorized to discuss the site in any way."
HealthCare.Gov's original developers can't tell you what's wrong with HealthCare.Gov.
When Development Seed was working on HealthCare.Gov, they made a conscious choice to keep all of their code open-source. CGI Federal's part of the Web site, which powers things such as account creation, is not open source, which means that Gundersen is essentially an outside observer like the rest of us.
Reddit commenters have also noted the difference. "The marketplace API (closed source) and the website frontend (open source) were built in connected but separate processes by two different entities," one commenter recently pointed out. "The code for the marketplace was not 'yanked', it was never published."
"If people had more insight into the code, and it was open, a lot more people would have a sense of what's happening," Gundersen said. "Since day one, we were open code. Right now, anyone can look at the raw source code, and there's none of the black box speculation. A lot of people are now getting to see how messed up IT procurement is. They can feel the pain of what's happened with some critical software."
Development Seed was hoping to buy its own coverage on the marketplace.
The firm had an even more personal stake in its software: It hoped to purchase coverage for employees through the health law's marketplace. Right now, it gives workers a set stipend to purchase their own plan in the individual market.
"This week I wanted to come in and get everyone registered," he said. That, as of this posting, has not happened.
I asked Gundersen how he thinks things will go in coming days, whether the site will be more functional anytime soon. He offered a few thoughts:
"This is going to get fixed. This is a lot of scale. They got, in 24 hours, more people trying to register than Twitter got users in 24 months. Do you remember how many fail whales [Twitter error messages] there were then? Let's not all hate on the government here."
KLIFF NOTES: Top health policy reads from around the Web
Many warned that Obamacare's Web sites would have errors. "Major insurers, state health-care officials and Democratic allies repeatedly warned the Obama administration in recent months that the new federal health-insurance exchange had significant problems, according to people familiar with the conversations. Despite those warnings and intense criticism from Republicans, the White House proceeded with an Oct. 1 launch." Juliet Eilperin, Amy Goldstein and Sandhya Somashekhar in The Washington Post.
State-based marketplaces are running a whole lot smoother. "While many people have been frustrated in their efforts to obtain coverage through the federal exchange, which is used by more than 30 states, consumers have had more success signing up for health insurance through many of the state-run exchanges, federal and state officials and outside experts say. Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, credited the relative early success of some state exchanges to the fact that they could leap on problems more quickly than the sprawling, complex federal marketplace." Robert Pear and Abby Goodnough in the New York Times.
Nearly one-third of Connecticuts' Access Health CT applicants are under 35. "The exchange received 1,157 applications, [Access Health chief executive Kevin] Counihan said. The silver plans were the most popular, drawing 49 percent of the early subscribers, while 26 percent picked gold plans. Twenty-one percent of customers have picked bronze plans, which have the lowest premiums available to most people and cover the lowest share of medical costs. Another 4 percent will purchase catastrophic policies, which are available only to people under 30 and offer the least comprehensive coverage." Arielle Levin-Becker in the Connecticut Mirror.