I don’t have much to say about the latest kerfuffle over what Jonathan Gruber said—you can find coverage pretty much everywhere—but I’m skeptical of the claim that the administration somehow hid the distributional consequences of the ACA. As Jill Horwitz and I wrote back in 2011, long before this latest fiasco:
The fairness of compelling healthy individuals to participate in community-rated risk pools was a core feature of the political debate. For just a few examples drawn from late 2009: A former Secretary of the Department of Health and Human Services published an op-ed in the Wall Street Journal deploring the “massively unfair form of income redistribution” that would occur when “younger, healthier, lower-income earners would be forced to subsidize older, sicker, higher-income earners.” A large insurer opposed to health-care reform released a study, widely covered by the press, showing that, under the ACA, “prices would trend much higher for healthy people,” particularly for younger customers, but that “[o]lder, sicker individuals would tend to see cost decreases.” And members of Congress hotly debated the fairness of community rating on the floor of both the House and Senate. We could go on.
Nor did the public debate ignore the ACA’s broader distributional consequences. At a hearing, Senator Cornyn characterized the ACA’s “subsidies, fee and taxes” as “a huge income redistribution.” Senator Ben Nelson thought the tax-and-transfer provisions amounted to “class warfare.” And the day after President Obama signed the ACA, the New York Times ran a front-page story declaring it “the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.” If the ACA’s distributional effects were hidden, they were not hidden well.
Gruber’s comment about the “stupidity of the American voter” is less easily forgiven. On that, I can’t improve on a quote from my friend David Hyman, who says lots of stuff I disagree with:
[D]on’t assume that people who disagree with you are stupid, misinformed, greedy, or evil. They may just have different preferences about health insurance, taxes, income redistribution, or the role of government in health care. If preferences differ, telling people they can’t understand the complexities won’t help matters. Such condescension just makes aggrieved citizens angrier.
