(Updated at 3:50 pm with additional material.)
Let's just get this out in the open: Jon Gruber has an agenda.
He really likes President Obama's Patient Protection and Affordable Care Act. Heck, Gruber, the MIT economist, even wrote an entire comic book about the law (and served as an advisor to the president in developing the national plan). So, when he joins forces with Stuart Altman, professor of national health policy at Brandeis and John McDonough, director of the Harvard School of Public Health’s Center for Public Health Leadership to compare the "impacts of ObamaCare, RomneyCare, and RomneyCandidateCare on health care consumers in every state," you've kind of got an idea of where they're coming from.
Still, the comparison is useful in reinforcing their message with some numbers.
What the analysts found in comparing the president's approach to candidate Romney's "composite" set of health care proposals — which includes repealing the ACA — is this: ObamaCare is better all around because it helps more people gain access to health insurance and pay for their care.
As Gruber put it in a conference call with reporters today, ObamaCare and RomneyCandidateCare offer two "completely different" visions. "Rather than fixing the problem, RomneyCandidateCare will make things worse," he said.
Indeed, families purchasing their own health insurance would pay almost double under RomneyCandidateCare, said Ron Pollack, Executive Director, Families USA, the nonprofit that sponsored the report. He said there would be a "huge difference" in the number of uninsured under each plan: By 2016, Pollack said, if ObamaCare is not implemented, 56 million people would be uninsured. But, he said, with ObamaCare, 30.7 million people would gain coverage and under RomneyCandidateCare 11.2 million would lose health care coverage. "Between the two plans, there's a difference of about 41.7 million people," Pollack said.
Overall, he said the plans are as "different as day and night. Middle-class families would pay much more out of pocket for their health insurance and the number of uninsured would skyrocket."
Specifically, the report found that across the nation: --Although both ObamaCare and RomneyCandidateCare provide help with health insurance premiums through the federal tax system, the former does it through tax credits and the latter through tax deductions. As a result, not only does ObamaCare provide help to more than twice as many people, but the average amount of help provided to each person is also much larger.
--Under ObamaCare, 20.3 million Americans purchasing individual health coverage would receive help with the cost of health insurance premiums in 2016 through tax credits.
--Under RomneyCandidateCare, fewer than half as many Americans (fewer than 10.1 million people) would receive help with premiums through tax deductions.
--Under ObamaCare, the average amount of help with premiums would be $4,231 in 2016.
--Under RomneyCandidateCare, the average amount of help with premiums would be $2,490 in 2016.
As a result, the size of the average premium tax credit would be 70 percent higher under ObamaCare than it would be under RomneyCandidateCare.
The report's state-by-state comparisons also showed more help for folks under ObamaCare compared to RomneyCandidateCare. On today's call, the focus was on a few specific states: Ohio, Florida and Virginia. (Surprise!)
Gruber spoke energetically about the similarities between ObamaCare and RomneyCare in Massachusetts, which he called an "enormous success.' "And make no mistake," Gruber added, "the Affordable Care Act was based on what we did here in Massachusetts."
As far as Medicare changes, the report paints a similar picture. Pollack noted that under ObamaCare, 25.7 million Americans get free preventive care; under RomneyCandidateCare — and by repealing the president's law — that benefit would be taken away.
Moreover, ObamaCare would expand Medicaid eligibility rules and allow more people to qualify and have access to care, Stuart Altman said. Under RomneyCandidateCare, however, that expansion would be eliminated and replaced by greatly reduced block grants, he said.
Altman painted a pretty dark picture of deteriorating health care under Romney: If ObamaCare is appealed and cuts that Romney and his running mate Paul Ryan have proposed are implemented, he said: "We won't have the quality and access to care we have now."
Gruber, responding to a question about the report's limitations given the vague nature of some of Romney's proposals and Gruber's own deep involvement in ObamaCare, said he stands by his numbers. "The most important things Romney has talked about can be modeled," Gruber said, adding: "There's never been a model that has gotten everything exactly right...I tried to be balanced about how I did it."
Here's a view from the other side by Josh Archambault at the Pioneer Institute (he calls the authors of the report "a trifecta of liberal health policy wonks"):
...it’s unclear how Gruber models Medicaid block granting in his analysis of RomneyCandidateCare. Jon said he assumes states will match any federal cuts, and still find a way to “save” an additional 25% of the cost of the program by further cutting reimbursement rates to try to keep some folks in the program. This, of course, would assume liberal states will not keep more individuals on the program with state dollars. It also presumes that states will not be able to find additional savings through innovative program reforms. Jon’s rationale sounds very similar to the dire predictions when welfare reform was being debated.
Gruber also seemed to imply that he used past House GOP proposals in his model as a proxy for Governor Romney’s plans. I believe the Romney campaign might take issue with that fact, as Governor Romney’s own proposals differ.
That said, I wanted to focus for a moment on one portion of the call that confused me. Jon once again tried to brush off any difference between the Massachusetts and federal laws. He said the only difference worth noting was the generosity of the subsidy levels and at what income level those subsidies are available. This statement comes with some surprise, as Jon sits on the Connector Board in Massachusetts, and has sat through a few different PPTs detailing the many steps needed to put the Connector on the path of federal conformity. Just as an example, the most recent meeting highlighted 124 different steps for the Connector.
Massachusetts has received or requested $99 million from the Feds to help move the Connector into compliance with the federal law, and they have yet to put in a Level 2 grant (often the largest) to the federal government. I wrote about it on the Pioneer Blog recently. This all seems like a ballooning price tag for two laws that are the same, don’t you think?
Jon uses his model to deflect criticism, by pointing to his own report, suggesting parallel outcomes between a national implementation of RomneyCare and ObamaCare.
One problem – the model doesn’t account for meaningful differences in the laws, and assumes everyone across the country will react in the same manner as those in Massachusetts. Safe assumption?
This program aired on September 27, 2012. The audio for this program is not available.