Perception Trumps Reality 

When it comes to the Affordable Care Act, separating truth from politics is a near-impossible task.

In the run-up to the recent deadline for enrolling in Obamacare, I called one of the few people with a hand in designing both the Affordable Care Act and the Massachusetts health-care reform plan signed into law in 2006 by then-Governor Mitt Romney.

Obviously, Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology, is personally invested in the success of health-care reform. So I expected him to give me an optimistic assessment of the future of the federal law.

click to enlarge Juan Williams
  • Juan Williams

He did not.

Instead, his voice sounded low-key and uncertain. He said it is "too early to tell" the fate of Obamacare.

His cautious judgment is that a final verdict on its success or failure might be three years away. To hear such fretting from an architect of the health-care plan opened the door to the fact that even its biggest supporters see trouble ahead.

Gruber agrees with Republican critics who complain that the administration lacks information about how many of the more than 8 million people now signed up previously lacked health insurance; how many are healthy and young; how many have paid for their coverage; and how much premiums will go up next year.

So, is Gruber resigned to the plan ending up in history's dumpster?

"No," he said, before emphasizing that the basic plan is working fine, despite the initial website problems. The danger to Obamacare, he says, has nothing to do with the final sign-up numbers. The plan has enrolled enough people, including enough young people, to be sustainable, he said.

The problem is that the law is still vulnerable to being crushed by the negative political narrative being created in Washington.

"The risk is that people who oppose the law will find enough troubling anecdotes in aggregate, that they scare the public and a majority of Congress and the White House into making bad political decisions that are detrimental to the law," he said.

In terms of the actual policy, Gruber said, there is not anything to worry about. But a threat to reform exists, he added.

The potential fatal threat he sees comes from the 50-plus votes taken by the House of Representatives to repeal the law, and the endless barrage of negative advertising by Republicans and their big-money backers.

"Those [House] votes, those advertisements are psychological attacks," he said. "They create an air of uncertainty. If people think it is not working, then they are less likely to support the law."

Without the political attacks, Gruber said, the Affordable Care Act will work.

"No doubt in my mind that if people left it alone for three years and let it run, it would be highly successful," he contends, "but that is not the world we live in."

Gruber recalls Romney and a representative of the conservative Heritage Foundation standing onstage with a Democrat, then-Senator Ted Kennedy, to sign the state law that is the model for the national version. The state law is popular and successful.

The reason congressional Republicans have no alternative to the federal Affordable Care Act, Gruber said, is that the individual mandate and exchanges at the heart of the current reform are originally "conservative, Republican ideas."

The GOP devised the Massachusetts plan, Gruber said, out of opposition to Hillary Clinton's proposal, during her time as first lady, of an employer-mandate to offer health insurance. The GOP also opposed a labor unions' proposal for a single payer system, much like Medicare, that pushed private insurance companies out of the equation.

As evidence of the current policy's success, Gruber points to millions of people now being able to buy health insurance; people not risking bankruptcy because of an accident or illness; and millions more people signing up for Medicaid.

He notes the popularity of letting young people stay on their parents' insurance plan until they are 26 and not allowing insurance companies to turn away people with pre-existing conditions. The economist also stresses that the United States has been slowing its annual increase in health-care spending since the plan was signed into law.

"The key question at the moment is whether people who support the law can make enough stories out of the winners to create a positive [psychological] effect and give it time to succeed." Juan Williams is a Fox News political analyst and former senior national correspondent for National Public Radio.

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