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Donald Trump, the celebrity businessman who has shaken up the Republican presidential race, has been attacking both Republicans and Democrats in his speeches and interviews. At one point in a July 11, 2015, speech in Phoenix, he took aim at the Affordable Care Act, President Barack Obama’s signature health care law.
He singled out the healthcare.gov website, which was unveiled in the fall of 2013 with a panoply of bugs and glitches, calling it "the $5 billion website for Obamacare, which never worked. Still doesn't work."
It’s a year and a half after the website’s troubled launch, and it’s been awhile since we’ve taken a look at how the website is doing and what it has cost to build. So we decided to see if Trump has any basis either for saying that the healthcare.gov website cost $5 billion or that it "still doesn’t work." (Trump’s camp didn’t respond to an inquiry from PolitiFact.)
Let’s take each of these claims in turn.
Did the website cost $5 billion?
The cost of the website has been a bone of contention ever since its launch, partly because federal contracting is complex, involving some 60 major contracts. Our friends at the Washington Post Fact Checker grappled with this question over the course of two separate reports that included several interim updates as new data surfaced.
Officially, the Department of Health and Human Services says the website cost $834 million. That’s the number offered by then-HHS Secretary-designate Sylvia Mathews Burwell at a Senate hearing on May 8, 2014.
As of Feb. 28, 2014, Burwell told lawmakers, the Center for Medicare and Medicaid Services -- the part of HHS responsible for the website -- "has obligated a total of approximately $834 million on marketplace-related (information technology) contracts and interagency agreements."
Not everyone has taken that figure at face value. Bloomberg Government undertook a study that used a more generous definition of the relevant federal spending. In the study, released in September 2014, researchers included several additional costs beyond the government’s official estimate -- $387 million in spending by the Internal Revenue Service and other agencies beyond HHS, as well as a $300 million contract to process paper applications, and additional spending by HHS after the cutoff for Burwell’s estimate.
Using this broader net, Bloomberg Government came up with a figure of $2.1 billion. That’s bigger than the official estimate, but it’s still not as large as what Trump said.
We asked the Bloomberg Government study’s author, Peter Gosselin, whether he thought the number could have more than doubled to $5 billion since the study was released 10 months ago. He was skeptical, saying that even if you add on a five-year follow-up contract with the firm Accenture, it should "only get you about halfway to $5 billion."
So Trump’s figure seems exaggerated. However, we have a hunch about where it came from, and while it’s wrong, it’s easy to see how someone could have made the mistake.
Using a provision of the Affordable Care Act, the federal government has spent nearly $5 billion in a series of grants to states to establish health care exchanges, according to tabulations made by both the Congressional Research Service and the Kaiser Family Foundation. This $5 billion statistic was widely reported and pops up easily during Google searches.
This would seem to suggest that the government had spent $5 billion on healthcare.gov. But that’s not quite correct, experts told PolitiFact. Rather, these grants were designed to boost state efforts under the law -- not the federal site -- and paid for a wide variety of things other than websites, including helping insurers prepare to join the exchanges, offering assistance through telephone hotlines, establishing marketing and outreach efforts for potential beneficiaries, and hiring "navigators" who help beneficiaries obtain care.
Both Gosselin and Jennifer Tolbert, the director of state health reform at the Kaiser Family Foundation, agreed that it would be incorrect to simply assume that the $5 billion in health insurance exchange grants is tantamount to spending on the website in the way Trump expressed it.
"It’s a different pot of money," Tolbert said. "It’s entirely separate from the money used to build the healthcare.gov website."
Is it true that healthcare.gov 'still doesn’t work'?
This part of Trump’s claim is easier to debunk. The proof is in the millions of Americans who have used the healthcare.gov website to obtain insurance coverage.
According to the most recent data released by HHS, covering the open-enrollment period between November 2014 to February 2015, a total of 11.7 million Americans selected or were automatically enrolled in an insurance plan for 2015 using the online marketplaces. Of that, 8.84 million signed up through the federal marketplace -- healthcare.gov -- with the remainder signing up through state-run websites. (These figures are not limited to those who have already made their first premium payment.)
So, clearly, the site is working.
This isn’t to say the system is working 100 percent perfectly. "There are some remaining issues, especially for certain populations, such as immigrants and people for whom it's difficult to verify their identity or income using electronic data," Tolbert said. "This can include people who have not been in the country very long or who haven’t yet worked long enough to establish a work and income history."
Still, the site appears to be functioning well in most cases. "Since the troublesome launch of healthcare.gov, (the government) has taken various actions to address the problems that impeded the initial use of the website and its supporting systems," the Government Accountability Office, Congress’ investigative arm, concluded in a March 2015 report.
"Operationally, the website works for the most part," said Tolbert of Kaiser. "It’s in much better shape than it was during the first few months of open enrollment."
Trump said "the $5 billion website for Obamacare … never worked. Still doesn't work." But experts say that, using the most reasonable definitions, Trump overstates the amount of money spent to create and fix healthcare.gov, and his claim that the website isn’t working -- and never did -- is debunked by the fact that millions of Americans have signed up for insurance through the site, even if some more limited glitches remain. We rate the claim False.
Donald Trump, speech in Phoenix, July 11, 2015
Bloomberg, "Obamacare Website Costs Exceed $2 Billion, Study Finds," Sept. 24, 2014
Kaiser Family Foundation, "Total Health Insurance Exchange Grants," accessed July 14, 2015
Kaiser Family Foundation, "Explaining Health Care Reform: Questions About Health Insurance Exchanges," April 1, 2010
Kaiser Family Foundation, "Explaining Health Care Reform: Questions About Health Insurance Exchanges," April 2010
Government Accountability Office, "CMS Has Taken Steps to Address Problems, but Needs to Further Implement Systems Development Best Practices," March 2015
Congressional Research Service, "Federal Funding for Health Insurance Exchanges," Oct. 29, 2014
Department of Health and Human Services, "Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report," March 10, 2015
Department of Health and Human Services Office of Inspector General, "An Overview of 60 Contracts that Contributed to Development and Operation of the Federal Marketplace," August 2014
Department of Health and Human Services Office of Inspector General, "Marketplaces Faced Early Challenges Resolving Inconsistencies with Applicant Data," June 2014
Senate Health, Education, Labor, and Pensions Committee, "Questions Sylvia Mathews Burwell by Sen. Lamar Alexander," May 8, 2014
Washington Post Fact Checker, "How much did HealthCare.gov cost? (Part 2)," Nov. 19, 2013
Washington Post Fact Checker, "How much did HealthCare.gov cost?" Oct. 24, 2013
The Fiscal Times, "Over $5 Billion and Counting for Obamacare Websites," May 13, 2014
PolitiFact, "Is healthcare.gov working 'great' now?" March 14, 2014
Email interview with Peter G. Gosselin, analyst with Bloomberg, July 13, 2015
Email interview with Aaron Albright, director of the media relations group at the Centers for Medicare and Medicaid Services, July 13, 2015
Email interview with Craig Palosky, spokesman for the Kaiser Family Foundation, July 13, 2015
Interview with Don White, senior media relations specialist with the HHS Office of Inspector General, July 13, 2015
Interview with Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation," July 13, 2015
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