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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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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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