Optimizing Experience in the Health Care Marketplace

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President Barack Obama’s nomination of Sylvia Mathews Burwell as the next secretary of health and human services presents an opportunity to look afresh at the decision-making processes for implementation of the Affordable Care Act.

More than 8 million Americans have already signed up for private health insurance through the marketplaces created under the Affordable Care Act—exceeding all expectations. A few months ago, no one would have thought this achievement was possible.

The federal marketplace—which sells health plans in 34 states—has come a long way. When it was first launched in October 2013, the federal marketplace was virtually unusable. Its website, HealthCare.gov, was slow, produced error messages, and crashed frequently. For weeks, the website was down an estimated 60 percent of the time. But a crisis management team led by Jeffrey Zients repaired more than 400 software bugs and significantly upgraded hardware to improve the system’s capacity.

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