US Centers for Medicare & Medicaid Services (CMS)
Healthcare.gov Launch Failure
Estimated impact: $2.1B total project cost; massive political fallout
The federal health insurance marketplace website crashed on launch day and remained largely unusable for 2 months. 55 contractors with no single integrator, late requirements changes, and suppressed testing reports.
Decision context
CMS leadership received multiple warnings about system readiness but proceeded with October 1 launch due to political pressure. Internal test reports showing catastrophic failures were not escalated to decision-makers. No end-to-end testing was performed until 2 weeks before launch.
Decision anatomy
Red = risk factor present · Green = protective factor present
Biases present in the decision
★ Primary driver · Severity estimated from bias type and decision outcome
Toxic combinations
Reference class base rates
Across all 143 curated case studies in our library:
Lessons learned
- Large government IT projects need a single accountable integrator
- Political deadlines must not override technical readiness assessments
- Testing reports must have guaranteed escalation paths to decision-makers
Source: GAO Report GAO-14-694, "Healthcare.gov: Ineffective Planning and Oversight," 2014 (Post Mortem)
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