At this point, it’s hard to believe there’s anybody left out there who thinks Obamacare is doing just fine. Jonathan Gruber, one of the major architects of the law, is one of them. “There’s no sense in which it needs to be fixed,” Gruber told CNN this week. “The law is working as designed.”
The Titanic was also working as designed. It made it most of the way across the Atlantic, after all.
That imagery aside, Obamacare probably isn’t sinking, or exploding, or any other destructive metaphor you want to use. Left untouched, the law can likely continue limping along pathetically. But working “as designed”? No one would design these outcomes.
Premium increases leave many with sticker shock
CNN invited Gruber on because consumers have sticker shock over next year’s Obamacare premium increases, which are rising an average of 25%. That’s a monstrous one-year increase, and it strains credulity for anyone to argue that this is a sign that things are just fine.
Here in our state, the increases are high, but not as high as the national average. The Puget Sound Business Journal estimates that premiums on our exchange will rise by an average of 13.6%. That ranges from a 7.4% increase for Molina customers to a 24.7% increase for those on Group Health Options. Premera rates are rising by 18.9% and Group Health Cooperative by 12.6%.
State Insurance Commissioner Mike Kreidler described the increases to the PSBJ as a one-time adjustment, and he expects rates to level off as insurers gain experience on the exchange. For some of the nation’s largest insurers, “gaining experience” has meant leaving the Obamacare exchanges altogether.
Higher tax penalty, more subsidies all around
Pressed on how the law could be improved, Gruber’s responses are telling. First, he wants a bigger penalty for not carrying Obamacare-approved insurance. “I wish the mandate penalty was stronger,” Gruber said on CNN. To say there isn’t a groundswell of political support for this option is putting it mildly.
He also wants the program expanded to cover illegal immigrants, which is not how the program was sold to the public back in 2009 and 2010. He at least acknowledges that doing so would cost a lot more money. “But subsidy costs would grow a lot too,” he told a Boston radio host, “so those would have to be paid for.”
Premium subsidies and mandate penalties are the carrot-and-stick of Obamacare. Gruber thinks the system needs larger versions of both.
If people knew the truth, Obamacare wouldn’t have passed
What Gruber and other Obamacare fans are saying today is markedly different compared to how the law was sold to the public. This is no surprise – Gruber is, after all, the man who said that the program’s lack of transparency was a necessary element to pass it, along with “the stupidity of the American voter”.
“In terms of risk rated subsidies, if you had a law which said that healthy people are going to pay in — you made explicit healthy people pay in and sick people get money, it would not have passed,” he said in 2014. He’s right on that. The “Healthy People Pay More Act” would not have passed.
Honesty comes later
It’s amazing how much more honest someone like Gruber feels free to be after the law is on the books. In defending the “Cadillac tax” on those with generous health benefits, he told the Boston radio host, “We should all pay more so others can get insurance.”
That’s a defensible position, but it’s another talking point I didn’t hear often in 2009. That’s back when we were being told Obamacare would save a family of four $2,500 a year – one of the all-time whoppers – and that “if you like your plan, you can keep your plan.” Not to worry, those people “never had real insurance to begin with,” Gruber says dismissively.
But don’t go laying any of this at the feet of those who championed this program and passed it, not on Gruber’s watch. “Obamacare is a Republican plan,” he said in defense. “It’s Romneycare on a national level.”
After all this debate and anguish over Obamacare, even its chief architect doesn’t grasp one of the main dividing lines: Republicans didn’t propose a one-size-fits-all national program. Massachusetts decided that program for itself. Arizona and Michigan and Florida should be free to choose the systems that work for their states. This isn’t inconsistent or hypocritical.
Change may happen at a slower pace on a state-by-state basis, but you know what? Under that approach, we wouldn’t be stuck with a troubled national program that few expect to be fixed or repealed any time soon.