Grubergate

November 18, 2014

In the last few days -- essentially since the election -- the Republicans have launched a new line of attack on Obamacare (the Affordable Care Act).  They are attacking what they call the "architect" of the ACA, who is quoted on video of making a handful of comments, which when they are heard out of context, seem quite damning. 

This latest line of attack on the ACA is rather bizarre in many ways.  Why? Here is why:

  • Everyone who closely followed the development and then passage of the ACA knows that it was written on Capitol Hill by staffers of the four key health committees in the House and Senate;
  • The legislation was developed over a long period of time, dating back to before the 2008 election, and it was based on a series of ideas that came from: Romney's plan in Massachusetts, ideas that had been floated on the Hill and in policy circles for quite a few years (dating back to the 1990s is not before), and legislation already written by key legislators (e.g. Harkin, Kennedy);
  • in the end, the final pieces of legislation that passed the House and Senate were crafted by the leadership, and by key Senators (e.g. Sen. Baucus) and House Chairs;
  • Given all this it is bizarre to now conclude that Prof. Gruber was somehow the chief author of the ACA;
  • the role Gruber played was in creating complicated simulation models that analyzed the elements of the legislation, and then providing advice on the legislation to White House and Congressional staff.
So how about his quotes?  Two major points:

  • the qoutes are taken out of context from larger speeches, and thus can seem more dramatic without context then if they are listened to in context, and
  • Professor Gruber, like most professors, often speaks in provocative ways when speaking to academic audiences, for effect.  He is certainly not the first professor to do so.  Does this mean his quotes are somehow crucial to understanding the ACA, why it passed, how it was designed?  No.  It means these are the opinions and observations of one academic, albeit a very smart one.
To understand what is going on here, one must understand that the purpose is to demonize a law that was passed by a significant majority in the House and Senate, and signed by the President.  In the end it is Congress and the President, and no one else, who were the responsible parties, the authors, the "architects" of the ACA.  The process by which the ACA was passed is well understood, has been much written about and -- frankly -- is not that unusual for the passage of any contentious, complicated laws; except for the way that the law was finally passed when it returned to the House.

The ACA should be judged by the actual law itself, and its effects, and not some made-up controversy about what one professor says when speaking to audiences across the U.S.  In the end, what Prof. Gruber says about the law is of no material significance in understanding the "Legislative intent" of the law.


 

SCOTUS (III): Smoking gun (CBO score) proves plaintiffs case has no merit

November 10, 2014

As I mentioned in two previous posts, the Supreme Court (SCOTUS) this past week decided to take the case of an appeal of a ruling by the 4th Circuit US federal court of appeals (King v. Burwell), in a case where the plaintiffs allege the Affordable Care Act (ACA) is ambiguous or conflicted on whether subsidies can be offered to lower-income persons who obtain coverage through Marketplaces established and run by the federal government.

Earlier I pointed out two huge flaws in the argument of the...
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SCOTUS (II): Legislative intent of ACA always clear, key Senate-House chairs say

November 9, 2014
As I noted earlier, the Supreme Court (SCOTUS) this past week decided to take the case of an appeal of a ruling by the 4th Circuit US federal court of appeals (King v. Burwell), in a case where the plaintiffs allege the Affordable Care Act (ACA) is ambiguous or conflicted on whether subsidies can be offered to lower-income persons who obtain coverage through Marketplaces established and run by the federal government.

My earlier post pointed to some fatal flaws in the arguments of the plaintiff...
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SCOTUS (I): Why the case against the ACA at Supreme Court has no merit

November 9, 2014

The Supreme Court has decided to take a case, ruling on another aspect of the legality of a key provision of the Affordable Care Act (ACA), whether it is legal for the federal government to provide subsidies for insurance coverage under the federal Marketplaces.  Though nearly every scholar has cast serious doubt on the logic of the case made by the plaintiffs, the Court has decided to take the case, likely because at least four Justices have certainly expressed their strong skepticism on the...


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A short political comment

September 10, 2014

Sometimes it amazes me how pundits seem to not either understand math, polls, or perhaps pretend not to do so.

Case in point:  pundits seem hyperbolic these days about President Obama's job approval ratings, saying how "historically low" they are, and how he is experiencing the "worst period" of polling in his presidency.  Evidence of this?  They cite just one data point, that the President has a low job approval rate of roughly 40-42%, depending on the poll.  Sounds not that great, right?

Well...
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Missouri Medicaid enrollment dropping

September 1, 2014

An article in today’s St. Louis Post-Dispatch points to a serious issue facing Missouri’s Medicaid program.  As the article points out, enrollment in the Medicaid program (called MOHealthNET in Missouri) has been dropping in the state for several months.  As reported by the Centers for Medicare and Medicaid Services (CMS) in their latest reports, with data through July, Medicaid enrollment is down -4.4% in Missouri since last year (from about 866,000 to about 830,000). This is the second ...


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The "Other St. Louis" and the Roots of Ferguson

August 31, 2014

During the turmoil that gripped Ferguson and St. Louis (and captured the attention of much of the nation) after the tragic shooting of Michael Brown when violence broke out (usually late at night) many turned to the famous quote of Martin Luther King Jr., who said: “a riot is the language of the unheard.”

We now know that the looting and violence that took place in Ferguson was quite limited, and by all means did not broadly characterize the protests that happened in the wake of Michael Br...


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The 2014 Senate Election Still Too Close to Call

August 29, 2014
As I said in an earlier post, I am a contrarian compared to pundits and others who seem to believe the odds are very high that the Republicans will take over the Senate.  In part, as I have written about before, I think Obamacare is much less unpopular than people think (and there is increasing evidence now of that) and I think it will become more popular over time. Also, I think the candidates who are vulnerable will do better than people think (e.g. Landrieu, Hagan).

As I have pointed out be...
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Missouri shows very small change in uninsured rate in latest Gallup survey

August 6, 2014

Gallup has released its latest results from its survey of how the Affordable Care Act (ACA) is faring nationwide, and it shows rather stunning (though in most cases likely unsurprising to health policy analysts) results of how this grand policy change is rolling out state by state.  Their main finding is that in states that implemented most of the features of the ACA the drop in the uninsured rate (which was already lower in the states that chose to implement the core mechanisms of the ACA) w...
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My contrarian view on 2014 senate election

August 4, 2014

I have long believed the pundits have it wrong (as they often do J ) on whether the Senate will flip to the Republicans, in their gloom and doom scenarios.  Mostly my view on this is because the press and pundits have so badly understood the Affordable Care Act (ACA) for so long, and how the public views it, and how it will be viewed by November.  In particular, I think the popular press view is that ACA is very unpopular and that therefore the Democrats and incumbent Senators will be punishe...


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About Me


Timothy McBride Timothy D. McBride, Ph.D. is a Professor at the Brown School, Washington University in St. Louis. Here you can find musings on health policy and other issues. Opinions are my own, and not those of my employer. Contact: mcbridetd@gmail.com