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Table of Contents Executive Summary....................................................................................................................... 3! Issues ......................................................................................................................................................... 3! Findings .................................................................................................................................................... 3! Recommendations ................................................................................................................................... 4! Purpose ........................................................................................................................................... 5! Overview ......................................................................................................................................... 5! Analysis......................................................................................................................................... 11! Public Administration Issues ...................................................................................................... 18! Recommendations........................................................................................................................ 20! References .................................................................................................................................... 25!

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! ! The federal Department of Health and Human Services was tasked with developing and implementing the Affordable Care Act website to allow consumers to enroll in insured health plans by a strict deadline of October 1. The launch of the website was unsuccessful due to insufficient time to fully develop a site, a lack of user experience testing, incomplete guidelines for operations, the unanticipated large number of applicants applying for healthcare, and the decision to use multiple 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 January 1, 2014. An overarching explanation for the failure of the federal healthcare web portal 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.

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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 different components of the site. 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. Quality assurance of the site was deterred due to the unwillingness to share information and communicate concerns, which lead to the improper delegation of responsibilities and accountability of duties. The Obama administration created a sense of urgency to meet deadlines and produce a product due to Republican opposition against the ACA. The influence of politics in decision-making increased the likelihood for failure. 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. 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. Tensions between administration and power, administration and politics, and administration and competing public values could have been loosened had the HHS been given clear goals by electoral institutions, provided adequate resources, and given autonomy 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 with the site as they are occurring. 2. Recruit a chief risk officer who can serve as the node that communicates between the departments and contractors involved in developing the site to the middle manager. 3. Cultivate an environment that supports open communication, so that all issues that arise are heard and documented. 4. Practice inclusive management, so that all different perspectives are involved in the process for decision-making and problem solving. 5. Act as self-stewards in the field to actively advocate for a voice in determining resources and making decisions.

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The purpose of this report is to assess the current state of the Affordable Care Act (ACA) website developed and implemented by the federal Department of Health and Human Services (HHS), and describe how a lack of planning and coordination has posed a challenge to public administrators at HHS. Public administrators at HHS have experienced challenges in leadership, contracting, and political power tensions. The report will describe the issue and challenges, illustrate the public administration and democracy tensions, and offer recommendations to improve the problem.

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The federal Department of Health and Human Services seeks to help provide the resources for Americans to lead healthy, successful lives by providing high-quality healthcare (HHS, 2013a). The HHS is the primary federal agency for protecting the health of all Americans and providing essential human services, especially for Americans who are least able to help themselves (HHS, 2013a). The Secretary is the chief managing officer who is responsible for overseeing eleven operating divisions, ten regional offices, and the Office of the Secretary. The HHS was tasked with overseeing several of the health reforms as a result of the ACA. The ACA was signed into law on March 23, 2010 despite bipartisan differences in Congress. Democrats were generally supportive of the bill because the ACA helps achieve a long-term goal of the Democratic Party to increase health care coverage and to require all individuals to obtain health insurance (or pay a tax penalty) ("History of the Passage of the March 2010 Health Care Reform Laws," 2011). Republicans, on the other hand, generally

found the bill unfavorable because the ACA would increase government spending and increase

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.

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,

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

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

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,

10

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.

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The 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

11

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

12

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

13

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 decisionmaking 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 highermanagement 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

16

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

17

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).

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The 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

18

by the public through the American democratic process, but Long would suggest that the American system of politics does not generate enough power for Obama to separate politics and administration. The American political system does not mandate leadership for the agency level, and agencies are expected to discuss issues, mobilize majorities in their terms, and create a working political consensus on measures determined by the executive since political parties have failed to do so (Stillman, 2010c). As implied by Long, the power dynamics between administration and politics is also a tension. Obama vowed to improve healthcare during his election, and this is an instance where politics determines the tasks for administration (Wilson, 1887). However, Wilson notes that politics should not manipulate bureaucracy, and that bureaucracy can only exist when services produced are separated from the politics of the people and the chiefs (Wilson, 1887). The implementation of the federal healthcare portal is an application of the ACA, which is an act of administration (Wilson, 1887). One element that contributed to the failure of the site is due to the inability of the HHS to work independently to rollout the site without the political pressures from the Obama administration (Stillman, 2010c). Although Wilson stressed the importance of creating administrations that are technically competent and politically neutral, the HHS must answer questions that are politically driven, are impacted by political influences, and are manipulated from political agendas and considerations (Wilson, 1887). As Wilson suggested, carrying out the interpretation of the politics-administration dichotomy would help the HHS in that the premise of administration may be grounded in politics, but the execution for efficient administration and policies are separated from partisan aims and biases (Wilson, 1887). Lastly, a tension also exists between democratic public values like transparency, citizen participation, and equity against administrative aims to perform tasks efficiently. Public

19

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.

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As 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

21

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

22

(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 selfstewards. 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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