The Many Hats of Jonathan Gruber

Dissecting a health care expert’s words

Campaign Desk has written about Jonathan Gruber many times—his role in building Obamacare; his television appearances touting the Massachusetts model; his comments in the newspapers as an expert on all things health care. Now, Gruber, an economist at MIT, is back offering his thoughts around the health care globe, so to speak. He is so ubiquitous that it may be tough for reporters, and surely the public, to understand who and what he is representing. So herewith is a Jonathan Gruber update.

Does he favor a single-payer plan? It turns out that Gruber has given advice to the state of Vermont along with Bill Hsiao who designed Taiwan’s single-payer health system. Tuesday Vermont’s new governor Peter Shumlin brought forth a bill that would abolish most forms of private health insurance and move the state’s residents into a publicly funded insurance pool. Details to be filled in later. The governor’s plan contains many recommendations made by Hsiao and Gruber.

Wearing his hat as a member of the board for Massachusetts’s Commonwealth Health Insurance Connector Authority, which oversees his home state’s health reform law, Gruber made some astonishing comments to the Boston Globe this week. It seems some folks in the Bay State are having trouble affording what the state considers an “affordable” premium for them. Some 43 percent of the state’s uninsured have family incomes less than $33,075 for a family of four, but many are ineligible for state programs because their employers offer insurance and pay one-third of the cost. Apparently these uninsured workers can’t afford to pay the rest. Said Gruber: “We may want to let them in [to government subsidized coverage] but it would cost money, and we would have to decide if the state wants to spend money that way.” Indeed it would, and the state is strapped with health care already consuming nearly 40 percent of its budget. Did Gruber admit that the state does not have the dollars to cover everyone after all?

Gruber was back in the news the other day because of a paper he wrote for the Center for American Progress, a democratic party-affiliated think tank. He argued that the individual mandate is essential for making health reform work. Yes, that’s the same mandate that the federal courts are deciding is legal or not. Some health experts are talking about Plans B and C in case the final verdict is a no. But Gruber believes that other ways to make people to buy insurance like imposing penalties for enrolling late won’t be as effective. NPR quoted a section of Gruber’s report discussing a point he often makes and one the press fails to challenge—that premiums for individuals buying insurance in Massachusetts have gone down by 40 percent while premiums nationwide for people buying their own insurance have increased 14 percent. Gruber neglects to say that while premiums went down for individuals, they continue to rise for the state’s small businesses—in the 20 to 26 percent range, some have told me. That’s because state law combines those two groups in the same risk pool. When premiums for some go down, premiums for others have to rise. That’s kind of the way it works in a private system.

Then there’s Gruber in his new role as a comic book writer. Hill & Wang, a division of Farrar, Straus and Giroux, signed him up to write a long comic book for the public explaining the federal health reform bill. He says he’s “the narrator guiding the reader through the law. It’ll have lots of pictures and text.”

Wonder what that narrator will say about people in Massachusetts unable to afford their premiums and small businesses struggling to pay theirs.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , ,