Will the health insurance exchanges work?

Jonathan Gruber • JULY 25, 2014

Jonathan Gruber of MIT describes how the Affordable Care Act was crafted and what its main provisions are. According to Gruber, the federal health reform law is modeled largely on the Massachusetts health reform efforts of the mid-2000s, led by then-governor Mitt Romney. Gruber describes the strategy of incremental universalism employed by the architects of the law to make the reforms fiscally and politically palatable. This particular video by Gruber came to prominence in July 2014 in light of opposing rulings by two different federal appeals courts over the issue of whether individuals living in states that do not create a state health insurance exchange are eligible for tax credits. In the Q&A portion of this talk (at 31:25), Gruber discusses the political forces at work in the implementation of the ACA, claiming that the reason the federal government has been slow to build its exchange is because it wants to squeeze the states to build their own exchanges, and clarifying that under the law, citizens who live in states without an exchange are not eligible for the subsidy. This drew national attention because it differs from what ACA proponents such as Gruber say the intent of the law was. Gruber has responded, saying that he misspoke.

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