TOPICS > Health

How does video of economist’s Affordable Care Act criticism hurt the law?

November 17, 2014 at 6:45 PM EDT

Editor’s note: The video of Jonathan Gruber and reaction to his statements were edited from the original broadcast due to online rights restrictions. It was not an editorial decision to delete them. You can see the Gruber video here, and President Obama’s reaction here and also GOP reaction from James Lankford here.

JUDY WOODRUFF: This weekend marked the start of a new round of enrollment for insurance coverage on the federal and state health care exchanges.

But, even as the Obama administration heralded the much smoother opening of the Web site, there was serious political blowback about the law. Last week, a year-old video came to light featuring an MIT economist, Jonathan Gruber, a former adviser to the administration, and a paid consultant who received $400,000 for his work during the creation and passage of the Affordable Care Act. He was an architect of the Massachusetts law that preceded the federal law.

Gruber spoke at a conference in Pennsylvania in October 2013. Here’s a clip from that where he spoke about how Congress would pay for the law when it comes to mandates and taxes and how voters might see that.

JONATHAN GRUBER, Massachusetts Institute of Technology: This bill was written in a tortured way to make sure CBO didn’t score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies, OK? So, it was written to do that.

In terms — in terms of risk-rated subsidies, if you had a law which said healthy people are going to pay in, it made explicit that healthy people pay in and sic people get money, it would have not passed, OK? Just like the people transparent — lack of transparency is a huge political advantage, and basically call it the stupidity of the American voter or whatever, but, basically, that was really, really critical to getting the thing to pass.

JUDY WOODRUFF: Yesterday, President Obama was asked by a reporter about Gruber’s comments and the idea that the true intentions of the law were not transparent to voters. Here’s part of what he said in response while in Brisbane, Australia.

PRESIDENT BARACK OBAMA: The fact that some adviser who never worked on our staff expressed an opinion that I completely disagree with in terms of the voters is no reflection on the actual process that was run.

We had a year-long debate, Ed. I mean, go back and look at your stories. The one thing we can’t say is that we didn’t have a lengthy debate about health care in the United States of America or that it wasn’t adequately covered.

JUDY WOODRUFF: Many Republicans and other critics are not persuaded by this argument.

Senator-elect James Lankford is from Oklahoma. Here’s a bit of what he said yesterday on “FOX News Sunday.”

SEN.-ELECT JAMES LANKFORD, (R) Oklahoma: I think Gruber’s comments show what is consistent in Washington, D.C. It’s this arrogance of centralized government. This administration really believes they’re smarter than everyone else and they just need to create the policy and impose the policy, and states exist only to be able to carry out their wishes from the central government. I think that’s exactly backwards.

The best thing that we can actually do is return health care decisions back to states, back to local authorities.

JUDY WOODRUFF: So, let’s dive a little deeper into Jonathan Gruber’s history here, as well as how the opening weekend of year two in health insurance enrollment went.

Julie Rovner of Kaiser Health News and Louise Radnofsky of The Wall Street Journal join me.

Welcome to you both.

So, let — before we get to Mr. Gruber, let me ask you first about sign-up this weekend.

Louise, how did it go? Overall, smoother than last year.

LOUISE RADNOFSKY, The Wall Street Journal: Certainly smoother than last year, relatively smoothly overall, a few bumps, particularly for people who were returning to the site to log in again, some of which seem to have been ironed out over the weekend.

There’s always the potential for new bumps to emerge in the next few days. Apparently, traffic on the site was higher today than it was over the weekend and that could present new challenges, but there’s also really big challenges to come a few weeks from now.

JUDY WOODRUFF: Julie, what would you add? What kind of bumps happened this weekend?

JULIE ROVNER, Kaiser Health News: Well, a lot of people who tried to sign either forgot their password. In some cases, apparently, they put in passwords or changed passwords and couldn’t get in.

But it’s very important for people who already have coverage through the exchanges to go back in and go through the process again, particularly if their income has changed. They need to plug that in. Also, in many cases, the prices of plans have changed. So just being re-enrolled into their current plan in many cases will be bad for people who currently have coverage. They really need to look again at everything that is out there.

JUDY WOODRUFF: So, Louise, you mentioned things will get more complicated in a few weeks. What are you referring to?

LOUISE RADNOFSKY: Well, one of the big problems actually stems from people doing exactly what they are being encouraged to do and going back to the site to shop.

There are parts at at the back end that consumers never see, but matter a lot.

JUDY WOODRUFF: And when you say the back end, you mean?

LOUISE RADNOFSKY: The underlying infrastructure. So, what people see is a much smoother application process. But there are bits and pieces that are missing.

And one piece that missing is the ability off the site to inform an insurer that a consumer is leaving and switching the another plan, which could lead to somebody being enrolled in two plans at the beginning of the year if they do what they’re being encouraged to do and shop around.

JUDY WOODRUFF: So, they’re right now working to make sure a lot of that doesn’t happen?

LOUISE RADNOFSKY: And the main advice to consumers that is being given is that they should contact the insurance company that they’re leaving to inform them of that in case the rest of the system doesn’t help them and make that information known.

JUDY WOODRUFF: Contact them directly, in other words.

And to clarify, people have — it started on November 15. It goes until to February 15.


But, of course, if you want a new plan for January 1, you have to sign up by December 15. That’s what Louise was referring to, is this is a very condensed period of sign-up compared to last year, when there were six months. So, everybody who has current coverage really should finish their process by December 15. And anybody who wants coverage that starts January 1 also needs to finish by December 15.

JUDY WOODRUFF: All right, let’s talk about Jonathan Gruber. He’s the man we just heard the comments about — health economist at MIT.

He did contract work for the Obama administration. He first worked, as we said, to develop the Massachusetts health care law under then Governor Mitt Romney.

Julie, you covered — you have covered the Obama health care debate internally from the very beginning. What was his role here and how did it play off what he did in Massachusetts?

JULIE ROVNER: Well, he obviously was integral to what happened in Massachusetts, but what his — his main role with the Affordable Care Act is that he has developed something called a micro-simulation model and that basically you can plug things in, possible policy changes, and see sort of how they might play out both in terms of the policy and in terms of how much they cost.

And that’s what the administration contracted with him for. He also contracted that to several states to look at the same thing. That’s what he’s most known for is his micro-simulation model. There’s not the impression that he was in the room when all of the key decisions were made, but he certainly was involved.

JUDY WOODRUFF: That’s the question, because, Louise, some have called him an architect of the health care law. How central was he to all this?

LOUISE RADNOFSKY: He’s certainly one of many, many central figures, which is not a very helpful explanation to people at this stage. But if you think about it, there were officials in each agency working on this from HHS to the White House. There were officials in many different congressional offices, and then there were outside experts as well, including some in academia.

So there’s no shortage of people out there who were involved. And the precise degree of everybody’s involvement often rises when they’re in the spotlight.

JUDY WOODRUFF: Julie, what about sort of the substance of what he was saying, that the administration went to great pains to conceal from the public that this was going to be a tax, as the Supreme Court later found it to be?

JULIE ROVNER: Well, there are a lot of interpretations of this.

One of the things that I think he may have been referring to is that they didn’t want to call it a tax while it was being debated because there were so many of those so-called Blue Dog Democrats, those moderate Democrats who didn’t want to have sort of the tax label hung around them if they were going to vote for this.

And remember the Republicans had taken a pass, so they needed all the Democrats in the Senate and almost all of them in the House, and they had those Blue Dogs, who were very, very concerned about voting for this. So there was — some of this I think was just semantic. They didn’t want to call it a tax. But, interestingly, in Gruber’s own book, he talks about how, with insurance, the sick have to pay for the healthy and the young have to pay for the old and that’s the idea of insurance, is that everybody pays, and then the people who need get.

So it was sort of odd to see him say something like that.

JUDY WOODRUFF: But whether he said it because it reflected what was going on, how much was that view, Louise, shared inside the administration based on your reporting on this?

LOUISE RADNOFSKY: Well, one of the key issues in what he’s saying is that it plays into fears of conservative opponents of the law like Senator Lankford that this was in some way a con or in some way passed without transparency or rammed down the throats of people without their involvement in it. And so that’s one part of it.

Some of the Gruber’s comments that have caused problems in the past actually spoke more directly to the issue that’s before the Supreme Court right now, and that’s certainly caused consternation among the administration before, because, to that point, he’s actually talking about a substantive issue, rather than a framing issue.

JUDY WOODRUFF: We’re talking about the subsidy or tax credit issue which the court has said it’s going to take up.

Julie, what’s your sense of how widely shared that view was that he expressed that, well, the voters, you know, they’re not going to understand this and, therefore, we don’t need to be completely transparent?

JULIE ROVNER: Well, nobody in politics would say that, which shows why he’s an economist in academia and not a politician.

And I think that’s why you see the president and yesterday we also saw Health and Human Services Secretary Burwell distance themselves from him and from those comments. It was just a very impolitic, in the literal sense of the word, thing to say.

But I think the problem is that there was already sort of this pile of dry kindling among the Republicans trying to figure out what to try to do about this law that they don’t like and they perceive the public doesn’t like. And this basically lit a match and threw into that pile of dry kindling.

JUDY WOODRUFF: Louise Radnofsky, how many damage to you — additional damage? There’s already — we already see public opinion continuing to drop in support of the health care law. How much does this hurt what the administration is trying to do, do you think?

LOUISE RADNOFSKY: Well, the timing is very, very particular to the open enrollment cycle.

It had been building up all week, but really seemed to explode into more mainstream attention around the time that the exchanges opened, and that may or may not be an accident. At the same time, the administration is wrestling with the Supreme Court, which also pretty much launched itself into most people’s attention right before open enrollment. There’s a lot of different things to juggle, in addition to the operation.

JUDY WOODRUFF: A lot to keep an eye right now, besides the opening this weekend.

Louise Radnofsky, Julie Rovner, we thank you.