Dr. Gruber explains what the 2024 presidential election means for the healthcare of millions of Americans

By: Claudia Amendoeira
SPJ New England correspondents for Student News Live


Doctor Jonathan Gruber, the architect of the Affordable Care Act and an MIT economics professor,
reflects on the impact of the ACA 14 years after its passage. Despite political attempts to dismantle it,
Gruber argues the ACA has reshaped the U.S. healthcare system by expanding coverage to 25 million
Americans and prohibiting discrimination based on health status. Yet, he warns that a potential expiration
of subsidies and ongoing resistance could undermine these gains, leaving millions vulnerable in the
upcoming years.


Amendoeira: This is Claudia Amendoeira, SPJ New England Student News Live correspondent and
we’re joined by Doctor Jonathan Gruber, the Ford professor of economics and the chairman of the
economic department at the Massachusetts Institute of Technology. He’s also one of the architects of the
Affordable Care Act, also known as Obamacare. Professor Gruber, thank you so much for joining us.


Dr. Gruber: My pleasure.


Amendoeira: It’s been 14 years since President Obama signed the Affordable Care Act into law. How
successful has the law been, and how big of an impact has it had on people’s lives?


Dr. Gruber: I think the law has been very successful. I’m biased because I worked on it, but I think if
you look at the facts, it has accomplished a lot of what it wanted to do, we’ve covered about 25 million
people with health insurance. Most importantly, we fixed insurance markets. Many of your listeners may
not realize, but before the Affordable Care Act, the US was really the only country in the developed world
where insurers could legally discriminate against the uninsured. They could say, I’m going to charge you
more if you’re sick, or I’m going to charge you more if you’re a woman, or I’m just going to deny you
coverage. They can’t do that anymore, and so now we’ve guaranteed all Americans can get health
insurance coverage, even if they’re sick.


Amendoeira: I know some Republicans have tried to repeal the ACA in the past, but their efforts have
come up short when the late Senator John McCain voted against scrapping the law. Do you think
Republicans this time around, after this election, will try to scrape it again?


Dr. Gruber: I am fairly confident they won’t. The law, when they went after it last time, was less than
50% popular. Now it’s about 60% popular. So I’m fairly confident they won’t. But you know, everything’s
a wild card now.


Amendoeira: And in case they did repel the law, how difficult would it be to replace the ACA?

Dr. Gruber: There’s no replacement. Let’s be clear, repeal or replace. You know, Trump said it best
when he said he has concepts of a plan. You know, there is no replacement. If they repeal the law, 25
million people lose health insurance. It’s that simple.


Amendoeira: If Republicans are not able to repeal the law, do you think there’s other avenues that would
go to constricted or limited, or what might they do?


Dr. Gruber: Yeah, absolutely. One of the most significant pieces— of one of the most significant
things the Biden administration did was they increased the generosity of the program. So, one of the
features of the Affordable Care Act is there are state marketplaces where you can buy health insurance,
and individuals can get tax credits to offset the cost of that health insurance. One thing that President
Biden did was pass a law which said that all Americans can get those tax credits, so that no one has to pay
more than 8% of their income for health insurance. That law will expire at the end of next year, and when
it does, the cost of insurance will go up for many, many Americans.


Amendoeira: And you don’t expect Republicans to pass something similar?


Dr. Gruber: I don’t know. I mean, it’s a pretty big hit to people. It’s going to hit red states harder than
blue states. But the problem is that, you know, the status quo is powerful, and they wouldn’t have to
repeal it, they just have to not approve extending it. It dies naturally, and that’s harder. Getting them to
actively approve extending it will be a lot of work.


Amendoeira: So, if that law expires, and say, the Affordable Care Act, for some reason, is repealed, what
is the healthcare landscape looking like for most Americans?


Dr. Gruber: If the Affordable Care Act is repealed, we’re back to a healthcare landscape where if
you’re an American who doesn’t get insurance from your employer or from the government, you are
uninsured. You are basically unable to get insurance that will cover you and protect you when you get
sick, you go back to a world of 50 plus million Americans without health insurance who are unable to get
fairly priced health insurance for them and their loved ones.


Amendoeira: How worried do you believe Americans should be about that chance?


Dr. Gruber: I think Americans should always be keeping an eye on what’s happening with our
healthcare system. It’s very complicated, and I think, once again, the particular odds that it all goes away,
I think, are pretty low, but far too far from zero to be comfortable.


Amendoeira: What would you like people to know or like to highlight about the Affordable Care Act
after this election cycle?


Dr. Gruber: I mean, I think I’d really like to highlight that people should educate themselves about
what it does. One way to do so is I actually have a comic book that explains the Affordable Care Act,
called health care reform, it’s available on Amazon. But generally, educate yourself about what the law
does, and don’t be misled. The law, basically, for most Americans, doesn’t do a whole lot. For most Americans, you have health insurance through your employer, the government. The law pretty much
leaves you alone, although there’s still some benefits. For example, if we repeal the law, students who can
get health insurance on their parents plan at age 26—that will go away. So many listeners are getting
health insurance on their parents plans. The ability to do that would go away in a number of states if we
repeal the law. So, there’s some features like that, but the main thing is, really the people who will suffer
will be people who are sick and don’t get health insurance from their employer or the government, and
now won’t be able to get health coverage. The whole idea of insurance is that we protect the sick. A world
where insurers can exclude the sick is not really a fair world, and I think that’s the major thing people
should know about a world without the Affordable Care Act.


Amendoeira: If you had a chance to still improve on the act because I know it didn’t get passed perfectly
like you wanted it to at the time. What are some of the weaknesses that you’re hoping to improve, maybe
not in this election cycle, but in the future?


Dr. Gruber: I think the main weakness is there remain many, many people who are eligible for free
or low cost insurance but aren’t signing up. And I think it’s about getting information to those people,
helping them sign up. I think we can do a lot more outreach. We can do a lot more to make people
recognize the benefits that are there. I think, you know, we still have about 25 to 30 million uninsured
Americans. Probably half of them could get health insurance for free tomorrow, and they’re not doing it.


Amendoeira: How so?


Dr. Gruber: Because we have, we have a Medicaid program which gives you health insurance for
free and we have these tax credits which offset the cost of private insurance for lower income people. And
so people don’t realize. So I think getting people information, helping them sign up, could go a long way
to getting to the remaining uninsured population.


Amendoeira: Those were all my questions. Thank you so much, Professor Gruber, thank you for joining
us.


Dr. Gruber: You bet, my pleasure, and certainly folks should look up—if you’re interested in
learning more about economics, you can tell your friends and colleagues, I have an online AP economics
class for people who want to learn economics, that’s on the MITx platform. If you want to take my MIT
class, you can take it for free through the OpenCourseWare program at MIT.


Amendoeira: Awesome. Thank you so much.