The White House’s tech team, 10 years after HealthCare.gov

On October 1, 2013, the federal government launched HealthCare.gov, a nationwide exchange mandated by the Affordable Care Act where U.S. residents shop for health insurance plans. It crashed the same day it debuted.

Outside government at the time, Mina Hsiang was on the team brought in to save the site. Now, 10 years later, she leads the U.S. Digital Service, the tech team born out of that crisis and housed in the Executive Office of the President.

The first woman and first Asian American to hold the administrator post at USDS, Hsiang leads a team of 220 engineers, service designers, product managers and procurement geeks doing tour-of-duty stints in government. 

These experts are deployed to agencies to work on key initiatives, such as the high-profile direct file project at the IRS, the redesign of the Social Security Administration’s SSA.gov website and the infant formula shortage crisis last year.

USDS marked its ninth anniversary last month, and Hsiang recently spoke with Nextgov/FCW to go over what has changed — an evolving portfolio and a growing focus on long-term work — and what remains constant — like the need for more tech talent in government. 

The following interview has been edited for length and clarity. 

Nextgov/FCW: This month marks a decade since the launch of HealthCare.gov. What has changed since then? 

Hsiang: The launch of COVID tests [website]… provides a nice bookend. It's not exactly the same, right? It wasn't called for in legislation. Obviously, it's not as complicated. 

But this notion that from the beginning to the end, you can do integrated implementation planning and do a really thorough job of having technical experts, implementation experts at the table from the beginning… has really allowed us to have a different narrative. Now we can roll things out successfully. We can have a launch that includes a soft launch, that includes a process for ensuring success. So that is the proof in the pudding of, we do it differently. 

I'm excited, also, that HealthCare.gov in and of itself — CMS has built that muscle and really manages and runs that highly successfully. They've continued to implement new features over time.

Other things that are different — agencies have [customer experience] offices… It [used to never be] the case that you walked into an agency and they knew what human-centered design was, or user research was, and now you almost never walk into an agency where they don't know what customer experience is or what user research is.

Nextgov/FCW: You talked a little bit about building tech teams into the policy and delivery process early on. What's the biggest blocker that you find to building those cross-disciplinary teams and conversations?

Hsiang: We've actually made a huge amount of progress on that… One of the blockers is potentially just capacity, right? It requires a lot of people to engage in a ton of different implementation programs. And to deeply understand all of the downstream systems, frankly, requires more people than it requires to just come up with really smart ideas and write them down. So the amount of effort that it can take to do a really good job of this just requires some scale and an investment in that scale.

There's some interesting complexities in what we're discussing here with regards to the continued disconnect between the Hill sometimes. One of the things that we've been really excited to see is the House launched a digital service team. Tech Congress has scaled up… I think that is incredibly important because they are driving a lot of policy as well, and ensuring that they have their tech experts who can help with that implementation focus is also incredibly valuable.

Nextgov/FCW: I'm curious how USDS as an organization has matured since it was founded?

Hsiang: We, over time, have invested in both crisis response projects and also programs that have the potential for long-term impact and transformation for programs and agencies. 

Looking at the example of the [Department of Veterans Affairs], we have had a team there for almost nine years. They have successfully helped the agency decide how they want to invest, build out capabilities internally, create the [Office of the Chief Technology Officer] that has a large number of headcount now, and they are leading the charge on building out better experience, launching this five-star mobile app.

So what in early days was sort of this hypothesis, right — I remember early days at the VA, and it was a very, very different environment — we know now that making that type of consistent investment with an agency that really wants to learn a new way of doing things and has that commitment can evolve things. That means that we as an organization now know it's worth our while to invest in those things, whereas earlier in USDS’ tenure, we had a much larger percentage of our portfolio allocated to crisis response. 

Because… we are trying to and have successfully, I would say, mitigated a bunch of those crises, it's a much smaller piece of the portfolio. 

We didn't want to over-allocate to these long-term projects in case that doesn't work out very well, and so now that it's demonstrated, that has a few advantages: it allows us to invest in it [and] it also gives a roadmap to agencies… There's a lot of demand for agency transformation type work where there didn't used to be, so that has been a real maturation, I think, of the environment. 

In the early days, agencies weren't always so excited about this whole notion of, “We’re going to change how we do everything.” They were pretty excited, like, “OK, but just help us get this thing out the door.” 

Now, they are pretty excited at the notion of, “We know we want to change how we align what's on our website with what comes into our call center. Can you help us think about how to build the backend system to do that better?”

Because they have that interest, that means that we have to design our teams to be longer-term, to have a different composition, to engage with the agency in a different way. So it really allows us to do more mature, different types of projects as well and make bigger longer term partnerships with agencies and invest in those.

Nextgov/FCW: How does USDS decide what it does? There are so many players — Congress, agencies, the White House, etc. — so I’m curious how it works.

Hsiang: We run a process here at [the Office of Management Budget] that is very tightly aligned with the auspices of our funding. So we focus on things that are well aligned with both our expertise and what we were created to do. And … we evaluate, basically, what will have the greatest impact — what will do the most good for the most people in the most need.

Nextgov/FCW: Do agencies come to you? Do you go to agencies? Does it depend?

Hsiang: At this point, there's a lot of demand. I would say mostly agencies come to us and have big things that they want to accomplish, sometimes in collaboration with policy work that they're working on with other parts of [the Executive Office of the President].

Nextgov/FCW: USDS is one part of a constellation of tech teams in government including the General Services Administration’s 18F. How do you distinguish yourselves?

Hsiang: We're super close collaborators. So I will say, you asked, what has changed? One of the other things that has changed is, I think, just the amount of collaboration and coordination across government. In times past, USDS and [the Office of the Chief Information Officer] didn't get along really well. We didn't always get along with [GSA’s Technology Transformation Services]. 

I talk to each of them almost every single day, so it's a very different environment in that way, and I think the constellation has become much more… integrated and collaborative, trying to figure out how we can all team together in order to continue lifting all boats. 

We have discovered that we each have a different role to play. So [Office of the Federal CIO], very much policy-oriented … So we're constantly feeding them, “Here's how we see things playing out in the market.” TTS is much more, has some combination of many more horizontal capabilities, so shared services, which we partner with them a lot on.

Nextgov/FCW: It seems like more and more agencies are building their own digital services teams. Am I right about that? What do you think about it?

Hsiang: Agencies have to decide they want to go in this direction. Building their own team is fundamentally deciding that they, in fact, want to make some changes, so I think it's an incredibly good sign… We work closely with the ones that we're aware of. 

We're a phone-a-friend to help them figure out… What is best practice? So I'm super excited about it. I think agencies taking it out on their own is like the best possible outcome here.

Nextgov/FCW: There have been some proposals on Capitol Hill to claw back some of the money given to USDS in the American Rescue Plan Act. What impact would that have if it were to happen? 

Hsiang: Taking away our funding would have the expected impact. We are a large organization that's providing critical services to agencies… Our entire funding goes towards personnel, and so anytime that that isn't available, then our ability to support agencies and the work that they're doing an implementation would be affected. 

Nextgov/FCW: What are your biggest priorities for the coming months and years at USDS? 

Hsiang: One is just continuing to evolve and mature our model. We have helped agencies and major programs have successful launches, helped ensure that major policies have implementation folks at the table and can be seen through to full implementation and then, as part of that, helping agencies grow and mature — so really continuing to flesh out and demonstrate the long-term impacts and scalability of implementation as a key part of policy execution.

Then the other big piece is… supporting and working with agencies to help them figure out, how much of this are we going to need long-term and in the future? How do we build the capacity internally? And how do we hire people to fill those teams?

We're really very focused on a whole of government — how do we help agencies really build this model in for themselves as well?