Looking at the National Health Care Debate through a Massachusetts Lens

May 2, 2011
by Victoria Groves, M-RCBG

One of the key architects of the Massachusetts health care reform effort brought his perspectives to bear on the national health care debate during a talk last Thursday (April 28) sponsored by the Mossavar-Rahmani Center for Business and Government (M-RCBG).

Jonathan Gruber, professor of economics at the Massachusetts Institute of Technology and an inaugural member of Massachusetts Health Connector Board, described the state law as a three legged stool that reforms insurance markets, mandates citizen participation and provides subsidies so that it is affordable.

Another “half leg” of that stool, he described, is the Health Connector, which helps residents find the right plan for themselves and their families. “We recognized that there wasn’t a good way to comparison shop,” said Gruber. “If you pull out any of these legs, the stool falls apart.”

As work began on the Affordable Care Act, Massachusetts was looked to as a model and in 2008 Gruber began working as a consultant with the Clinton, Edwards and Obama presidential campaigns on health care reform. “It would have been hard, if not impossible, to do national health care reform without an example of how it would work,” he said. “The federal bill is much more ambitious than the Massachusetts bill.”

Gruber discussed the benefits included in the bill, including an increase in health care coverage available to children, an end to lifetime and most annual limits on care, allowing children under age 26 to stay on their parents’ health insurance and access to recommended preventative services without cost. Funds will be raised to pay for the bill through reduced spending on the Medicare program, tax increases including those to the pharmaceutical and medical device industries and a “Cadillac tax”, which levies an excise tax on employers with considerably rich health benefit plans. “If you put all of these together, we’re looking at $140 billion over the first decade,” said Gruber. “But what’s really impressive is what happens after ten years…the bill is more than paid for and increasingly over time.”

But the bill is still in a precarious position, Gruber explained, and could be toppled by the Supreme Court, by individual states during implementation, or by the 2012 presidential election. “If Barack Obama loses, the next president could kill it,” he said. “In Massachusetts, the mandate worked because we have a culture of health care coverage here…but will it work nationally? Will there be protests?”

Gruber’s talk was part of M-RCBG’s business and government seminar series.

Jonathan Gruber speaking at the event. Photo credit, Paul Sherman.

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