Obamacare supporters and opponents usually war from a distance, but get them together, and they act a lot nicer.
Two leading voices on the Affordable Care Act shared a stage Wednesday to air their vastly different opinions of the health care law at a forum hosted by Sun Life Financial.
One of them was Jonathan Gruber, the former White House consultant who has inadvertently made statements appearing to support a major legal challenge to the law but who now insists he misspoke.
The other was Michael Cannon, a health policy expert at the libertarian Cato Institute who trumpeted the legal questions raised in King v. Burwell well before the Supreme Court ever took up the case.
The two men are hoping for opposite rulings when the Supreme Court hands down its King v. Burwell ruling in June.
Gruber wants the justices to side with the Obama administration and allow the law’s insurance subsidies to keep flowing around the country. Cannon wants them to side with the challengers and block the subsidies in a majority of the states, dramatically undermining the administration’s implementation of Obamacare.
Those differences — and other points of disagreement over the law — were clear during the 15 or so minutes they shared the stage. But instead of verbally beating each other up, they acknowledged their disputes and pointed out a few areas of agreement, too.
Where they disagreed
Did Congress intend for the healthcare law’s insurance subsidies to hinge on whether states choose to run their own marketplaces or rely on the federal government’s healthcare.gov website? Gruber says no; Cannon says yes.
“All the framers of this law are alive, and everyone asked them, and no one who worked on this law has said this means what the plaintiffs say it means,” Gruber said.
Cannon said that’s what he used to believe, until he started researching the issue.
“There’s absolutely no evidence — I mean none either in the statute or legislative history — that anyone in Congress contemplated, believed this law would offer subsidies in states that didn’t establish exchanges,” he said.
Then there’s the question of whether low-income Americans could afford health insurance at all without the subsidies. According to Cannon, getting rid of the Affordable Care Act and its regulations for insurers to cover more services would go a long way toward that goal.
But Gruber noted that the annual cost of family coverage can be as high as $12,000 — and even reducing that cost by one-third still wouldn’t make it affordable for a family with income at the federal poverty level.
“I think you have to realize that without subsidies, people aren’t going to buy health insurance. It’s just not affordable,” Gruber said.
Where they agreed
Both said the recent slowdown in health care spending is more due to consumers spending their health care dollars more wisely and less because of the Affordable Care Act. Health care spending reached historically low levels over the last few years, although some recent reports suggest it’s on the rise again.
“I think the primary culprit is probably a shift to higher cost-sharing and limited networks,” Gruber said. “I think the Affordable Care Act deserves some credit but not the majority.”
Cannon said the health care law “could have had a role,” but also credited changes in consumer spending on health care.
“I think a more likely culprit for the reduction in spending growth is growth in health savings accounts and so-called consumer-directed health plans,” he said.
