The main problem with the original healthcare.gov was that it was built by contractors under the old contracting model of "fill as many seats with bodies as you can, win the contract, and charge by the hour". That business model creates a perverse economic incentive that doesn't leave a lot of room for creativity, and certainly doesn't do anything to create trust between the federal agency that requires software and the team that ends up building it. I would also say that the hiring bar for contractors, compared to 18F, the USDS, etc, is, frankly, pitiful.