Even overseas, President Barack Obama couldn’t escape questions about a domestic controversy surrounding the health care law.
Footage emerged last week of Jonathan Gruber, an MIT economist, claiming more than a year ago that the "stupidity of the American voter" and a "lack of transparency" were key to passing the Affordable Care Act. Why is that of interest? Because Gruber played a role in helping to write and pass the health care law.
Obama, however, downplayed Gruber’s involvement while speaking at the G20 summit in Australia. A reporter asked Obama about Gruber’s remarks.
Obama replied, "I just heard about this. I get well briefed before I come out here. 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."
Here, we wanted to hash out what role Gruber had in crafting the Affordable Care Act and whether Obama accurately recounted his involvement.
Getting to know Gruber
Gruber was instrumental in helping Massachusetts build its health care overhaul from 2003 to 2006, sometimes called "Romneycare" after former Massachusetts Gov. Mitt Romney, which is widely viewed as the model for the federal law. Both share the central idea to require everyone to purchase health insurance and similarly set up a marketplace to allow individuals to buy coverage.
In 2012, Republican presidential candidate Rick Santorum claimed a Romney adviser, who turned out to be Gruber, admitted that the Massachusetts law was the model for the federal law. We rated Santorum's claim was Mostly True. We’ve interviewed Gruber from time to time as an expert on both laws.
A month after Obama took office in 2009, the Department of Health and Human Services contracted Gruber to provide "technical assistance in evaluating options for national healthcare reform," according to a federal job posting.
Gruber was the only person considered for the position because he developed a "proprietary statistically sophisticated micro-simulation model that has the flexibility to ascertain the distribution of changes in health care spending and public and private health sector costs."
Essentially, Gruber had built a way to accurately estimate health care costs and spending for varying health insurance proposals, federal programs and tax policies, and it made him "uniquely positioned to provide the analytic work."
For this, Gruber was paid quite well. According to a recent story by the Washington Post Fact Checker, Gruber earned about $400,000 for his work with HHS and the Obama administration. He has since made seven figures helping various states set up their own insurance marketplaces in compliance with the Affordable Care Act.
The Gruber Microsimulation Model
Gruber’s model, called the Gruber Microsimulation Model, was able to predict important factors, such as how much insurance would cost for individuals to buy in each state.
Another important element of Gruber’s model is its outputs were very similar to those produced by the Congressional Budget Office, Congress’ nonpartisan fiscal scorekeeper. With everyone watching closely to see how the Congressional Budget Office was evaluating the fiscal impact of the various health care bills, having a model that could accurately predict what the CBO would say was very valuable to the process.
Gruber declined to comment for this story. But others who worked on the legislation have rebutted claims that Gruber was "an architect" of the Affordable Care Act.
John McDonough, a Harvard health policy professor who was a senior adviser to the Senate Health and Education Committee when the law was written, told PolitiFact that Gruber’s involvement was important, but it did not involve the actual writing of the bill.
"Jon had designed an economic model to be able to estimate any changing set of parameters like how much a policy would cost and how many people would get covered and various other effects," said McDonough, who also worked with Gruber in Massachusetts. "In 2009 and 2010 he took a year off from his teaching and other duties and worked out of his home in Lexington, Mass., and was basically on call almost 24-7 to run various models for us."
"But he was not in the room in the determination of what policies would be in or not be in the law," McDonough added. "I was one of an army of people who were in the room at various times. Jon was not."
Neera Tanden, the president of the Center for American Progress who served as a senior adviser for health reform at the Department of Health and Human Services from 2009-10, wrote in an op-ed for the Wall Street Journal that Gruber "did not make policy, nor did he work for the White House, HHS, or any congressional committee."
"The true architects of the ACA are the members of the Senate Finance and Senate Health committees who wrote the bill," she wrote.
Gruber and Obama
Gruber may not be an architect of the bill, like some have said, but referring to him as "some adviser" is somewhat misleading as well. After all, his microsimulation model made him uniquely qualified for the critical task of figuring out just how much all of this would cost the government and consumers.
Such a flippant characterization also dismisses Gruber’s influence on Obama’s positions on health care reform in the lead-up to his presidential bid and during his first year in office.
A video clip that resurfaced last week showed then-Sen. Obama speaking at a Brookings Institution event in 2006 (Gruber spoke later in the event). During his remarks, Obama said about the forthcoming Hamilton Project, "You have already drawn some of the brightest minds from academia and policy circles, many of them I have stolen ideas from liberally, people ranging from Robert Gordon to Austan Goolsbee; Jon Gruber; my dear friend, Jim Wallis here, who can inform what are sometimes dry policy debates with a prophetic voice."
Further, Gruber visited the White House a dozen times from 2009-10, according to visitor logs.
This included a July 20, 2009, meeting with Obama. According to a 2011 NBC news story, Obama or his staff sat down a dozen times during 2009 with three different people who helped advise Romney’s health care overhaul in Massachusetts, including Gruber.
"The White House wanted to lean a lot on what we’d done in Massachusetts," Gruber told NBC News in 2011. "They really wanted to know how we can take that same approach we used in Massachusetts and turn that into a national model."
Gruber also had meetings with many of the heavyweights on Obama’s economic and health care staff: Peter Orszag, then the director of the Office of Management and Budget; Larry Summers, director of the National Economic Council; Jason Furman, the deputy director of the National Economic Council; and Jeanne Lambrew, the director of the Office of Health Reform for the Department of Health and Human Services.
Obama said Gruber was "some adviser who never worked on our staff."
This careful wording significantly downplays the MIT economist's role.
Gruber was an adviser. But he was not just "some adviser," an especially flip characterization. By HHS’ own documentation, Gruber was considered "uniquely positioned" for a contract job assisting with Obama’s health care reform efforts. In that sense, he was a very important adviser.
Further, while Gruber never worked "on our staff," he was paid by the federal government quite handsomely, and worked very closely with the staff. His economic simulation model was very important to those writing the bill, even if he wasn’t the person deciding what would make the legislation and what would be left at the cutting board. He also met with Obama in the White House and had a dozen meetings that often included some of the most senior members of Obama’s economic and health care teams.
The statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.
White House, "Remarks by President Obama at G20 Press Conference," Nov. 16, 2014
PolitiFact, "Nancy Pelosi says she doesn't know who Jonathan Gruber is," Nov. 13, 2014
Email interview with Jessica Santillo, spokeswoman for the White House, Nov. 17, 2014
Bio for Jonathan Gruber, MIT economics professor, accessed Nov. 17, 2014
Email interview with Gruber, Nov. 18, 2014
Phone interview with John McDonough, professor at the Harvard School of Public Health, Nov. 17, 2014
Washington Post Fact Checker, "Did Jonathan Gruber earn ‘almost $400,000′ from the Obama administration?" Nov. 14, 2014
Federal Business Opportunities, "Technical Assistance in Evaluating Options for Health Reform," accessed Nov. 17, 2014
Wall Street Journal, "Getting to the Bottom of ‘Grubergate,’" Nov. 13, 2014
White House, Visitors Access Records, accessed Nov. 17, 2014
NBC News, "White House used Mitt Romney health-care law as blueprint for federal law," Oct. 11, 2011
The Brookings Institution, "Restoring America’s Promise of Opportunity, Prosperity and Growth," April 5, 2006
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