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A Project of The Annenberg Public Policy Center

The ACA-Gruber Connection

President Obama and Rep. Nancy Pelosi downplayed the contribution of MIT economist Jonathan Gruber to the Affordable Care Act, after controversial comments by Gruber came to light, while Republicans exaggerated his role. We find both sides are stretching the facts.

Pelosi, in a blog post, said the White House “sometimes consulted” with Gruber, who “testified at one Senate hearing.” He actually testified at three. Obama called him “some adviser who never worked on our staff.” Sure, he wasn’t on the White House staff, but he was a paid consultant on health care, earning hundreds of thousands of dollars over the course of a year.

Meanwhile, conservatives, including Rep. Bill Cassidy of Louisiana, have overstated Gruber’s role, claiming he was “the architect” of the law. Those who worked closely on the law say he ran economic models to determine the outcome of certain proposals.

Gruber’s ‘Stupidity’ Comment

Earlier this month, video began circulating online of Gruber speaking at an October 2013 conference on health economics at the University of Pennsylvania, where he said the ACA had been written “in a tortured way” so that the Congressional Budget Office wouldn’t “score the mandate as taxes.” He went on to say, “Lack of transparency is a huge political advantage. And basically, you know, call it the ‘stupidity of the American voter’ or whatever, but basically that was really, really critical to getting the thing to pass.”

He apologized in a Nov. 11 interview on MSNBC, saying he “basically spoke inappropriately.” But he said political infeasibility meant the law had to be structured a certain way, and that political pressure led to an “incomplete law.” (Washington Post Fact Checker Glenn Kessler wrote an explainer piece on what Gruber was talking about on taxes.)

But the damage of the “stupidity” comment was done. When Obama was asked at a Nov. 16 press conference about Gruber’s comments on lack of transparency and that “the voters are stupid,” the president responded:

Obama, Nov. 16, Brisbane, Australia: 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.

Three days earlier, Pelosi’s office said in a blog post:

Pelosi Fact Sheet on Jonathan Gruber, Nov. 13: Indeed, at the dozens of hearings on the health reform bill by the three health committees in the House in 2009, with 181 witnesses, Jonathan Gruber was never a witness. He testified at one Senate hearing. … The White House sometimes consulted with Gruber on health issues.

Pelosi’s post correctly says that Gruber was tapped for his economic modeling expertise and that his microsimulation model was used to estimate the impacts of the health care bills. But the blog post downplays his role by saying he never testified at a House hearing and wrongly claiming he “testified at one Senate hearing.”

Earlier, on Nov. 13, Pelosi said of Gruber at a weekly briefing to reporters, “I don’t know who he is,” a comment her staff later said meant that she didn’t know Gruber personally. We found seven instances of Gruber being cited on Pelosi’s leadership website, and the Washington Post dug up November 2009 comments by Pelosi, in which she specifically named Gruber in citing his work.

The Gruber comment is playing big in the Louisiana Senate race, which is headed for a Dec. 6 runoff between Cassidy and Democratic Sen. Mary Landrieu. Cassidy wrote on Nov. 11 on Twitter: “The architect of ObamaCare says it passed because voters are stupid. Does Landrieu think that about #LAsen voters?”

And two ads in the race seized on the controversy: An ad from the Conservative Campaign Committee calls Gruber “the architect” of the ACA, while a spot by Freedom Partners Action Fund calls him “Obamacare’s chief architect.”

So was the MIT economist “the architect” of the federal law, or just “some adviser”? His actual role lies somewhere in between, according to statements by Gruber and others who worked on the law.

Gruber’s HHS Contract

Gruber was hired by the Department of Health and Human Services for a one-year contract to provide “technical assistance in evaluating options for national healthcare reform,” as a Feb. 25, 2009, federal job posting indicates. The posting said he was uniquely qualified for the position not only because of his expertise in health economics but his “proprietary statistically sophisticated micro-simulation model” that could determine the impact of changes in health care policy.

Gruber’s consultancy work wasn’t made public until it was reported in early January 2010. Fox News then reported that Gruber was paid almost $400,000 for the contract, an amount that was recently confirmed by the Washington Post’s Kessler.

Gruber’s expert status in health economics was very well-known before Obama took office. We have quoted him on the subject many times, including in February 2008, when we cited his microsimulation modeling of different approaches to a health care overhaul and noted he had talked with the Obama, Hillary Clinton and John Edwards campaigns on the topic. Gruber, who is also director of the health care program at the National Bureau of Economic Research, had advised former Massachusetts Gov. Mitt Romney and the state Legislature in developing the state’s 2006 health care law, which shares several similarities with the subsequent federal law.

In an April 2012 opinion piece, published by MassLive.com, a western Massachusetts news site, Gruber described himself as one of the architects of the Massachusetts law, but not the federal law: “Several of the architects of Massachusetts reform, including myself, worked closely with the Administration and Congress to translate the lessons from Massachusetts onto the national stage.” Similarly, his MIT bio says he was “a key architect” of the Massachusetts overhaul and a “technical consultant” to the Obama administration from 2009 to 2010 who “worked with both the Administration and Congress to help craft the Patient Protection and Affordable Care Act.”

Gruber declined to comment for this article.

Pelosi’s post is wrong to say he testified only once before the Senate. He testified at three Senate hearings on health care overhaul options and legislation: a May, 12, 2009, Senate Finance Committee hearing; a June 11, 2009, Health, Education, Labor, and Pensions Committee hearing; and a Nov. 3, 2009, hearing also before the HELP Committee.

At the June hearing, he said he wanted to “congratulate the committee on a draft bill which really provides a terrific framework for fundamentally transforming healthcare in the United States.” At the November hearing, his remarks included the results of modeling the impact of the Senate Finance Committee bill on small businesses using the Gruber Microsimulation Model, which he said had been “widely used for policy analysis at both the state and federal level” and was similar to CBO’s modeling.

White House visitor logs show that Gruber visited the White House on several occasions, as reported by both the Wall Street Journal and The Hill. His six visits in 2009 include a July 20 group meeting with Obama and other economists.

Former administration advisers and congressional staff have said Gruber was tapped for his modeling work, not to draft the legislation.

Ezekiel J. Emanuel, who was the special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, told us in a phone interview, “He was a consultant who, quote, ran the numbers,” meaning that “he did the estimates of how much, when you change things in a proposal, how that would affect the number of people covered and the cost of the program.”

Emanuel, who is now vice provost for global initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, says calling Gruber “the architect” of the law is “utter, total nonsense.”

In his book “Reinventing American Health Care,” which was published in March, Emanuel mentions Gruber just once, in the context of economic modeling. He writes that the White House was concerned about how the CBO would score the cost of legislation. Emanuel says his brother, then-White House Chief of Staff Rahm Emanuel, and the president “established a very firm maximum-cost limit” of $1 trillion over 10 years. They wanted half of the money to come from savings in existing programs and half to come from new revenue, Emanuel writes.

Here’s the mention of Gruber:

“Reinventing American Health Care,” March 2014: During the development of the ACA the administration undertook 2 major efforts to create a shadow CBO “score” function. First, the Department of Health and Human Services contracted with Jonathan Gruber, an economist at MIT, to predict the CBO score. Gruber was picked largely because he had developed an economic model of the health care system that the CBO borrowed and refined to create its own model.

David Bowen, who was the health policy staff director for the HELP committee first under Sen. Ted Kennedy and then Sen. Tom Harkin, told us he “wouldn’t describe any single person as the architect of the ACA,” as a number of people made major contributions to the law. As for Gruber, he says, “There were a few experts that we sought as sounding boards and counsel, and he was one of those.”

Gruber’s economic modeling was very helpful, especially early on before there was draft legislation that CBO could score, says Bowen, who left the Senate committee shortly after the ACA was signed into law and is now an executive vice president at H&K Strategies. But Gruber wasn’t one of the people writing the legislation or working on it into the early hours. “I know who was there at 3 in the morning and I know who wasn’t,” Bowen says. Gruber wasn’t.

“It was an excellent analytical model,” Harvard University’s David Cutler, a former Obama adviser, was quoted as saying in the Wall Street Journal. “He was not a formal adviser. It was all about his model.”

Neera Tanden, a senior adviser to HHS from 2009 to 2010 and now the president of the left-leaning Center for American Progress, wrote in an op-ed in the Journal that Gruber was a consultant who “did not make policy.” She said, “The true architects of the ACA are the members of the Senate Finance and Senate Health committees who wrote the bill, with input from dozens of congressional hearings and bipartisan round tables.”

Emanuel told us that Gruber didn’t write any portion of the legislation “that I was intimately involved with,” but he couldn’t speak for the whole bill. Emanuel says the fact that Gruber calls himself an architect of the Massachusetts law doesn’t make him an architect of the federal one. The two laws are related but “distant cousins.” That sentiment was expressed by Romney’s former secretary of health and human services, Tim Murphy, who told us in a 2011 interview that there were many differences between the laws, though they shared certain mechanisms. However, Murphy said, “unless you were going to go to single-payer, how many mechanisms really are there to use?”

Gruber’s October 2013 full comments at the University of Pennsylvania conference show that he’s a supporter of the law, even though he is quite critical of some of its provisions. He may not have written it, but Obama’s claim that he was “some adviser” and Pelosi’s focus on how many committee hearings he attended brush aside the fact that he was a highly paid consultant whose modeling work was instrumental in determining the impact of health care policy. At the same time, the claim by Cassidy and conservative ads that Gruber was “the architect” overstates the role of an economic consultant and overlooks the role many others in the administration and Congress played in creating the law.

— Lori Robertson