Thoughts on the Obamacare technology glitches

The past week’s news has been dominated by lots of very strong opinions about the new Affordable Care Act (aka “Obamacare”). I’m certainly not going to get into a political debate here, but I thought I’d write a few words about the much-publicized technology platform issues.

On October 1st the ACA online exchanges launched, giving consumers the opportunity to shop online for various new private health insurance policies. Sixteen states and the District of Columbia have created their own exchanges, while federal government is managing a marketplace for the other 34 states on Healthcare.gov. Some sites have operated very smoothly, while some (notably the Federal one) have overloaded, crashed, and frustrated thousands of users.

For those of us who develop online platforms for a living, this is obviously an opportunity to see what the learnings are.

Here are my thoughts:

1. Simplicity always trumps complexity.
Many of the state sites (Oregon and Kentucky, for example) kept to a nice small set of core features for the initial launch, while the Federal site simply tried to do too much. It’s always better to launch a new platform where you have totally nailed a few key features. More features can always be added later. Nail it, then scale it.

2. Nothing good ever comes from too many cooks in the kitchen.
The federal site had many many stakeholders, and lots of different vendors working on it. The design was contracted to Aquilent, who then subcontracted to Development Seed. The principle back-end development was done by the Canadian company CGI Federal, the data hub was built by Quality Software Systems, and user authentication and identity is being handled by Experian. The first registration page on Healthcare.gov is 2,099 lines of HTML code, plus it’s reaching out for 56 JavaScript calls and 11 CSS files. That’s a very “heavy” page, and my guess is that it’s because of the number of cooks involved, and very little emphasis on optimization of the kitchen.

3. Open trumps proprietary.
It’s worth noting that the entire front-end was designed and developed by Development Seed, an agile development shop using an open-source content management platform (Drupal), and an open-source code repository (Open by Design
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