[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
EXAMINING OBAMACARE TRANSPARENCY FAILURES
=======================================================================
HEARING
before the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
DECEMBER 9, 2014
__________
Serial No. 113-164
__________
Printed for the use of the Committee on Oversight and Government Reform
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
DARRELL E. ISSA, California, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, JR., Tennessee CAROLYN B. MALONEY, New York
PATRICK T. McHENRY, North Carolina ELEANOR HOLMES NORTON, District of
JIM JORDAN, Ohio Columbia
JASON CHAFFETZ, Utah JOHN F. TIERNEY, Massachusetts
TIM WALBERG, Michigan WM. LACY CLAY, Missouri
JAMES LANKFORD, Oklahoma STEPHEN F. LYNCH, Massachusetts
JUSTIN AMASH, Michigan JIM COOPER, Tennessee
PAUL A. GOSAR, Arizona GERALD E. CONNOLLY, Virginia
PATRICK MEEHAN, Pennsylvania JACKIE SPEIER, California
SCOTT DesJARLAIS, Tennessee MATTHEW A. CARTWRIGHT,
TREY GOWDY, South Carolina Pennsylvania
BLAKE FARENTHOLD, Texas TAMMY DUCKWORTH, Illinois
DOC HASTINGS, Washington ROBIN L. KELLY, Illinois
CYNTHIA M. LUMMIS, Wyoming DANNY K. DAVIS, Illinois
ROB WOODALL, Georgia PETER WELCH, Vermont
THOMAS MASSIE, Kentucky TONY CARDENAS, California
DOUG COLLINS, Georgia STEVEN A. HORSFORD, Nevada
MARK MEADOWS, North Carolina MICHELLE LUJAN GRISHAM, New Mexico
KERRY L. BENTIVOLIO, Michigan Vacancy
RON DeSANTIS, Florida
Lawrence J. Brady, Staff Director
John D. Cuaderes, Deputy Staff Director
Stephen Castor, General Counsel
Linda A. Good, Chief Clerk
David Rapallo, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on December 9, 2014................................. 1
WITNESSES
The Hon. Marilyn Tavenner, Administrator, Centers for Medicare
and Medicaid Services, Department of Health and Human Services
Oral Statement............................................... 5
Written Statement............................................ 7
Mr. Jonathan Gruber, Ph.D., Professor, Massachusetts Institute of
Technology
Oral Statement............................................... 18
Written Statement............................................ 20
Mr. Ari Goldmann, Independent Consultant
Oral Statement............................................... 22
Written Statement............................................ 24
APPENDIX
QHP Privacy and Security Certification Agreement................. 102
2012-12-06 Elmendorf-CBO to DEI - Cost estimate HR 4872 HR 3590.. 113
AAF Midnights and Medicare....................................... 114
2014-10-30 WP Affordable Care Act Opponents Cherry-Picking Their
History........................................................ 116
EXAMINING OBAMACARE TRANSPARENCY FAILURES
----------
Tuesday, December 9, 2014
House of Representatives,
Committee on Oversight and Government Reform,
Washington, D.C.
The committee met, pursuant to call, at 9:32 a.m., in Room
2154, Rayburn House Office Building, Hon. Darrell E. Issa
[chairman of the committee] presiding.
Present: Representatives Issa, Mica, Turner, McHenry,
Jordan, Chaffetz, Walberg, Lankford, Amash, Gosar, Meehan,
DesJarlais, Gowdy, Farenthold, Lummis, Woodall, Massie,
Collins, Meadows, Bentivolio, DeSantis, Cummings, Maloney,
Norton, Tierney, Clay, Lynch, Cooper, Connolly, Speier,
Cartwright, Kelly, Welch, and Lujan Grisham.
Also Present: Representative Rice.
Staff Present: Melissa Beaumont, Assistant Clerk; Molly
Boyl, Deputy General Counsel and Parliamentarian; Lawrence J.
Brady, Staff Director; Ashley H. Callen, Deputy Chief Counsel
for Investigations; Caitlin Carroll, Press Secretary; Sharon
Casey, Senior Assistant Clerk; Steve Castor, General Counsel;
John Cuaderes, Deputy Staff Director; Howard A. Denis, Senior
Counsel; Adam P. Fromm, Director of Member Services and Member
Operations; Linda Good, Chief Clerk; Elizabeth Gorman,
Professional Staff Member; Meinan Goto, Professional Staff
Member; Frederick Hill, Deputy Staff Director for
Communications and Strategy; Christopher Hixon, Chief Counsel
for Oversight; Emily Martin, Counsel; Laura L. Rush, Deputy
Chief Clerk; Jessica Seale, Digital Director; Andrew Shult,
Deputy Digital Director; Matthew Tallmer, Investigator; Rebecca
Watkins, Communications Director; Tamara Alexander, Minority
Counsel; Meghan Berroya, Minority Chief Investigative Counsel;
Aryele Bradford, Minority Press Secretary; Jennifer Hoffman,
Minority Communications Director; Una Lee, Minority Counsel;
Juan McCullum, Minority Clerk; Dave Rapallo, Minority Staff
Director; Cecelia Thomas, Minority Counsel; Michael Wilkins,
Minority Staff Assistant.
Chairman Issa. The committee will come to order.
Without objection, the chair will be authorized to declare
a recess at any time.
The Oversight Committee exists to secure two fundamental
principles. First, Americans have a right to know that the
money Washington takes from them is well spent. And, second,
Americans deserve an efficient, effective Government that works
for them.
Our duty on the Oversight and Government Reform Committee
is to protect these rights. Our solemn responsibility is to
hold Government accountable to taxpayers because taxpayers have
a right to know what they get from their Government.
It is our job to work tirelessly in partnership with
citizen watchdogs to deliver the facts to the American people
and bring genuine reform to the Federal bureaucracy. This is
and has been our mission for 4 years that I have been honored
to serve.
Ms. Tavenner, before I begin with my opening statement, I
want to make you aware, in hopes that your people will deliver
documents pursuant to a subpoena that expired--or didn't
expire--that was due 8 days ago related to the documents behind
your coming before this committee and giving false and
misleading testimony related to the so-called 7.3 million
enrollment figure.
We asked for and we received only half of the documents,
and the documents that were excluded were the ones that created
the talking points and the people who caused you to use
inarticulate language that carefully allowed you to say 7.3
million without disclosing that that included at least 400,000
dental plans. That was subpoenaed. It was clearly understood.
Last night we received a huge data dump, and it was not in
there. And it makes it very difficult for us to go forward with
some aspects of today's hearing, as you can imagine. It is
clear that this hearing in no small part was not because of
what Obamacare is about, not about the health care. It is about
honesty and transparency to the American people.
Today's hearing is likely the last full committee hearing
of this Congress. This committee has a primary obligation--and
has lived up to that obligation--to look at Government to make
Government more transparent and accountable.
And, at times, Members on both sides of the dais have
helped in trying to create that transparency, but no Government
program needs increased transparency and accountability and
honesty more than the Affordable Care Act, known as Obamacare.
It has proven time and time again to, in fact, have made false
claims.
Every Member on both sides of the dais can agree that the
Affordable Care Act, or Obamacare, is a large, expensive
program reliant on a complex network of Government programs
which significantly impact the lives of all Americans and, yet,
the history of design passage and implementation with the law
is fraught with half-truths and deceptions.
Here are just a few of the false claims the administration
has made regarding Obamacare: If you like your doctor, you will
be able to keep your doctor, period. Nothing in Obamacare
forces people out of their health plans. No change is required
unless insurance companies change existing plans. Healthcare
inflation has gone down every year since the law--Affordable
Care Act--has been passed and that it now has the lowest
increases in healthcare costs in 50 years. To that, we add we
have got close to 7 million Americans who have access to health
care for the first time because of Medicaid expansion. If you
like your plan, you can keep your plan.
When trying to pass Affordable Care, Obamacare, the
administration repeatedly claimed that the law's individual
mandate was not a tax. However, months after passage, in a
brief defending the mandate's constitutionality, the Justice
Department argued just the opposite, that it was a tax.
One of our three witnesses this morning offered a simple
answer to this change in position.
[Video shown.]
Chairman Issa. I wish it was right and we had made it all
transparent.
Professor Jonathan Gruber is considered by many as the
architect of Obamacare. As a former Obama Administration
official put it, ``Professor Gruber was the man on Obamacare,
the guru of health care.'' The official went on to say, ``I
remember that, when I was at the White House, he was certainly
viewed as an important figure in helping to put Obamacare
together.''
No one can look at the amount of money he has--he was
compensated for his work on Obamacare, totaling millions of
dollars, and think that our witness was anything but a critical
player in the Affordable Care Act.
Current administration officials, however, have attempted
to distance themselves from Professor Gruber ever since he
stated and started telling the truth about the tactics used to
pass this law. In fact, the Center for Medicare and Medicaid
Services urged the committee not to seat him with the
Administrator next to him.
And, Dr. Gruber, we think you are right to be there. In
fact, we believe that this is a perfect pairing, a pairing of
individuals who are, in fact, responsible for what we know and
don't know before, during and after the passage and
implementation of the Affordable Care Act.
September 18, 2014, the Administrator, Ms. Tavenner, came
before us and testified that, in fact, there were 7.3 million
people enrolled in the--and I quote this carefully--``health
insurance marketplace coverage.''
That tortured language had not previously been used and it
followed a series of document requests after we were told,
``Trust us. The numbers are good,'' in which we discovered
that, in fact, 7.3 million would have to include a fairly large
400,000 individuals in more or less $50-dental plans.
Obviously, when you say you met a goal--and the difference
between making a goal and not making a goal are plans that
nobody would consider a key element of the Affordable Care Act.
HHS initially failed to provide any documents to explain how
the numbers had been interpreted.
On October 1, 2014, the committee requested the enrollment
data underlying Tavenner's 7.3 million enrollment announcement.
Our requests were met with delays, runarounds that bordered on
obstruction.
After weeks of negotiation, CMS finally provided the
enrollment data, printed on spreadsheets with--and for those
who are at my age will appreciate this--6 point font, something
that is not readable even with your reading glasses. When
electronic copies were demanded and the data was finally
delivered, Oversight investigators discovered that all of the
hundreds of spreadsheets were, in fact, password-protected and
locked.
After further negotiation, we finally were able to receive
the passwords and recognized that, all along, there had been an
inherent deception. This was quickly discovered and would have
been discovered by anybody simply by putting the spreadsheets
in ascending order of dollars.
On November 21, 2014, only after it was publicly noted, the
committee discovered the administration was willing to
acknowledge 393,000 dental plans in the figures released in
September.
Moreover, HHS included dental plans in its enrollment
figures not just once, but twice. The Agency has included
dental plans in its November enrollment figures and has now
been forced to revise down to not greater than 6.7 million
enrollees.
The administration claims it made a mistake; however, there
is great skepticism about that and, particularly, the term
``mistake,'' when it appears as though, instead, HHS and CMS
were too clever in an attempt to inflate the numbers and say
they had met a goal.
It is a small technical error in many ways whether you had
7.3 million or 6.7 million if, in fact, it is simply a matter
of whether you made a goal or didn't make a goal. But when you
doctor the books, add additional numbers, and then use careful
language so that you didn't lie, but you did deceive, that is
exactly what we are concerned about here at this committee.
The American people have a right to know the honest
numbers. Management has an obligation to know it if they are,
in fact, going to be accountable to the taxpayers for doing
their job. And, in fact, the American people expect no less.
Professor Gruber is often said in Washington to be the
definition of a gaff. That is when somebody accidentally tells
the truth. You made a series of troubling statements that were
not only an insult to the American people, but revealed a
pattern of intentional misleading the public about the true
impact and nature of Obamacare, which is in many ways--in many
ways you helped craft.
Today we will have an opportunity to ask you to apologize
for your low opinion of the American people and, hopefully,
apologize for the false information on which the analysis of
what the Affordable Care Act would do was built, leading to the
disappointments we see here today.
Chairman Issa. And, with that, I would recognize the
ranking member for an opening statement. He is not here.
All Members will have 7 days to submit opening statements
for the record.
We now go to our----
Mr. Cartwright. Mr. Chairman.
Chairman Issa. --panel of witnesses.
Ms. Marilyn Tavenner is the Administrator of Centers for
Medicare and Medicaid Services at the Department of Human
Services.
And Mr. Jonathan Gruber is a professor at MIT--Mr. Massie
would probably normally introduce him--the Massachusetts
Institute of Technology.
Pursuant to the committee rules, all witnesses will be
sworn in before they testify.
Mr. Cartwright. Mr. Chairman.
Chairman Issa. Would you please both raise your right hands
to--stand and raise your----
Mr. Cartwright. Mr. Chairman.
Chairman Issa. --right hand to take the oath.
Just a moment. I am going to go through where I am, please.
Do you solemnly swear or affirm the testimony you are about
to give will be the truth, the whole truth, and nothing but the
truth?
Please be seated.
Let the record reflect the witnesses have answered in the
affirmative.
Please be seated.
For what purpose does the gentleman seek recognition?
Mr. Cartwright. Thank you, Mr. Chairman.
At this time, Mr. Chairman, in the absence of the ranking
member, may I ask that--we have a minority witness, Mr. Ari
Goldmann, for whom we thank your indulgence, and we would ask,
for convenience sake, since we have a small panel here, that
Mr. Goldmann be added to the panel and be sworn in and testify
at the same time.
Chairman Issa. You know, I appreciate your suggestion. He
is not a Government witness and not an expert in the--any of
the facts being discovered today. So we will leave him on the
second panel. But I thank you for your suggestion.
Ms. Tavenner, you are recognized for 5 minutes for your
opening statement.
WITNESS STATEMENTS
STATEMENT OF THE HON. MARILYN TAVENNER
Ms. Tavenner. Thank you, Mr. Chairman, Members of the
committee.
I appreciate the opportunity to appear here today and
answer your questions about CMS's continuing work to provide
affordable, high-quality health care to the Americans we serve.
In my previous----
Chairman Issa. Ma'am. Ma'am. I appreciate it, but if you
would just pull the mic a little closer. Thank you. Sorry.
Ms. Tavenner. In my previous appearance before your
committee, I reported a number of Americans that were enrolled
in marketplace coverage and had paid their premiums that
included both medical and dental coverage. Simply put, this was
a mistake.
Some individuals with both medical and dental coverage were
counted twice in the individual affected enrollment numbers.
Moving forward, only individuals with medical coverage will be
included in our individual effected enrollment numbers.
We are now providing weekly snapshots of the 2015
marketplace data, including the number of consumers who have
submitted an application, contacted the call center, or visited
the Web site.
We have also created a new data office and have named our
first chief data officer. This new office will help CMS
strengthen its processes and, more broadly, will help CMS
better harness and use our vast data resources to drive better
care at a lower cost.
While this mistake was regrettable, it should not obscure
the fact that the Affordable Care Act is working. We have 6.7
million Americans enrolled in healthcare coverage and paying
their premiums as of October 15th, and the number of uninsured
adult Americans is down 26 percent.
Since the beginning of the open enrollment period, about
9.1 million additional individuals have enrolled either in
Medicaid or CHIP. For the first year of a new program, this is
a tremendous accomplishment.
2015 open enrollment is off to a solid start. Because of
new choices and more competition in the health insurance
marketplace, many consumers are now able to shop and find even
more affordable options in the second year of the program.
We have seen a 25 percent growth in the number of issuers
participating in the marketplace, which means that more than 90
percent of consumers will be able to choose from at least three
or more issuers and over 60 percent of the marketplace
enrollees are able to renew coverage at their middle level for
less than $100 a month after tax credits.
Those already covered should come back to the marketplace
to review their options for next year. People may find an
option that is either more affordable or better suits their
needs.
We have improved the consumer experience as well. The
shopping and enrollment process is simpler, faster, and more
intuitive for consumers. With the new streamlined application,
for many consumers, we have reduced the number of screens from
76 down to 16, with fewer clicks to navigate through the
questions for most consumers.
Consumer interest is strong. Since open enrollment began
last month, there have been over 765,000 plan selections, 48
percent of which are new consumers. Over 1.5 million
applications have been submitted, and there have been more than
5 million Web site visits.
But the Affordable Care Act is not just about coverage. In
recent years, we have seen historically low growth in overall
healthcare spending. Just last week, CMS's Office of the
Actuary released their 2013 health expenditure report, which at
3.6 percent is the lowest reported growth in health
expenditures since this report's inception in 1960.
While the recent slow cost growth has multiple causes,
reforms to the Medicare and Medicaid programs are meaningful
contributors to these gains and are improving quality as well.
For example, preliminary estimates indicate that hospital-
acquired infections by 17 percent from 2010 to 2013, resulting
in 50,000 fewer admissions and over $12 billion in cost
savings.
I am proud of our progress at CMS. I am proud of our team.
They work hard every day to ensure better, safer, and more
affordable health care.
Thank you. And I look forward to your questions.
[Prepared statement of Ms. Tavenner follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you.
Before we go on, I would recognize the ranking member for a
unanimous consent request.
Mr. Cummings. Mr. Chairman, one of our Members had
requested that we have an additional witness to come on the
panel, and I would ask unanimous consent that--ask the chairman
to allow that to happen.
Chairman Issa. Okay. Are there any objections?
Mr. Meadows. I object. I object.
Chairman Issa. Would you reserve for a moment?
Mr. Meadows. Sure.
Chairman Issa. Let me ask the witnesses.
Ms. Tavenner, do you have any objections to having--I
understand he is a waiter at a local restaurant who thoroughly
loves Obamacare. He is actually an independent consultant. I
apologize. They gave me a new title.
Do you have an objection to Mr. Ari Goldmann, an
independent consultant, being on the panel with you?
Ms. Tavenner. I have no objection.
Chairman Issa. That is good. He likes your stuff.
Mr. Gruber, do you have a problem with an independent
consultant being on the panel?
Mr. Gruber. No, I do not.
Chairman Issa. Then, I have no objections.
Does the gentleman continue to reserve?
Mr. Meadows. I withdraw my objection.
Chairman Issa. Okay. Hearing no objections, while they seat
Mr. Goldmann, I would ask the ranking member, since he was
unavoidably detained, to do his opening statement.
And then we will go to you, Mr. Gruber.
Mr. Cummings.
Mr. Cummings. Thank you very much, Mr. Chairman.
Before I begin, I know today is your last hearing as
chairman of the Oversight Committee, and I want to thank you.
As you said a few moments ago, we have taken this journey
together, and it has been a great journey.
I said during your hanging of your portrait right there----
Chairman Issa. Thank you for saying that I was hung.
Mr. Cummings. --that I believe that everybody who comes
along your path comes along your path to make you better. And I
will tell you, Mr. Chairman, you have made me a better person
in so many, many ways.
And I want to thank you. I want to thank you for your
service. I want to thank you for your dedication. I want to
thank you for taking the time to get to understand these issues
in a very, very intricate way.
And a lot of people have not been in the many meetings that
we have sat in where you--I don't know how you do it, but you
seem to be an expert on so many, many things. And I know it is
because it is your passion. And so I want to--I thank you.
In a way, I wish we had last week's hearing on the DATA Act
today because it was such a positive note for bipartisanship
and it showed what we can do when we work together.
I also want to thank you for inviting our witness, Ari
Goldmann, who is here to testify about his own personal
experience obtaining health insurance after we passed the
Affordable Care Act.
I would like to welcome you, Mr. Goldmann.
And so, Mr. Chairman, I know we may disagree today about
the Affordable Care Act, but I hope we will do it in a
respectful way based on substance and the evidence before the
committee.
In 2010, Democrats in Congress passed the landmark
Affordable Care Act to give millions of people across the
country health insurance. We banned insurance companies from
discriminating against people with pre-existing conditions, we
established significant new measures to hold down healthcare
costs, and we provided extra assistance to those who needed it.
Today, based on the evidence before us, the ACA is working.
Millions of people are now covered through the exchanges and
Medicaid expansion. And according to The New England Journal of
Medicine, the rate of uninsured has dropped by over 4
percentage points since last year. That is a 26 percent
reduction in the ranks of the uninsured in just 1 year.
The evidence also shows that the ACA is bending the cost
curve. The growth of national healthcare spending decreased to
3.6 percent last year. That is the lowest rate on record since
the 1960s. In addition, reforms of healthcare delivery methods
have saved $12 billion by reducing the number of hospital-
acquired conditions.
Despite these clear benefits, Republicans have spent the
last 4 years doing everything in their power to repeal the
Affordable Care Act, dilute it, undermine it, and oppose it.
This has become one of their chief political goals. They have
taken 53 votes to repeal or weaken the law, and last year they
shut down the Government for 16 days in a failed attempt to
delay its implementation.
In our committee today, we will hold our 29th hearing on
the Affordable Care Act. That is a stunning number, more than 2
dozen hearings. But not one, not one, has helped to implement
the ACA more effectively or efficiently. It pains me to imagine
the good we could have accomplished had we devoted that same
amount of time and resources to more constructive efforts. And
so I mourn what could have been.
Unfortunately, this hearing is no different. As far as I
can tell, we are here today to beat up on Jonathan Gruber for
stupid, I mean, absolutely stupid, comments he made over the
past few years and then drill and grill Administrator Tavenner
about what appears to be an inadvertent mistake in reporting
ACA enrollment numbers.
This may be good political theater, but it will not help a
single American get health insurance. It will not help a single
person get well. It will not help a single person get the care
that they need.
Let me be clear. I am extremely frustrated with Dr.
Gruber's statements. They were irresponsible, incredibly
disrespectful, and did not reflect reality, and they were
indeed insulting.
I was in Congress when this law was debated. And Dr. Gruber
does not speak for me or the chairman of the other committees
who worked tirelessly on this bill.
We debated this legislation for nearly a year before it was
finally passed and signed by the President. We held 79 hearings
and markups in the House of Representatives alone. Never once
did I believe or did anyone suggest that we were somehow hiding
our goals from the American people.
But worst of all, Dr. Gruber's statements gave Republicans
a public relations gift in their relentless political campaign
to tear down the ACA and eliminate health care for millions of
Americans.
Many Republicans now allege some kind of Democratic
conspiracy, citing the praise for Dr. Gruber's work from
President Obama and other Democrats, but that, too, is
completely wrong.
Let me highlight some additional praise Dr. Gruber received
for his work. Dr. Gruber received the following thanks for his
contributions to healthcare legislation--and I quote:
``Jonathan Gruber at MIT devoted hours and hours to an
essential economic model.'' That statement was not from
President Obama, but from the Republican nominee for President
in 2012, Mitt Romney. He thanked Dr. Gruber personally at the
signing ceremony for the Romneycare in Massachusetts in 2006.
A day earlier Mitt Romney wrote an op-ed in The Wall Street
Journal entitled ``Health Care for Everyone? We Found a Way.''
This is what he wrote--and I quote--``Jonathan Gruber of MIT
built an economic metric model of the population and, with
input from insurers, my in-house team crunched the numbers.''
Governor Romney said this and said this, too, ``Because
health insurance will now be affordable and subsidized, we
insist that everyone purchase health insurance from one of our
private insurance companies. And so all Massachusetts citizens
would have health insurance. It is a goal Democrats and
Republicans share, and it has been achieved by a bipartisan
effort through market reforms.''
And, as I close, this is exactly what the ACC was modeled
on and was supposed to be, but Governor Romney was wrong about
one thing: that goal was not shared by Republicans in
Washington.
For the last 4 years, House Republicans have been trying to
repeal the ACA, but they never explain what they will replace
it with, what they will replace it with. In a few weeks,
Republicans will control both houses of Congress and they will
be out of excuses.
Governing responsibly does not mean eliminating essential
healthcare protections for our constituents, all of our
constituents, with no alternative. It means promoting the
health and economic security of millions of Americans who
desperately need help.
And, with that, Mr. Chairman, I want to thank you for your
courtesy. I want to thank you for your service to committee.
And I yield back.
Chairman Issa. I thank the gentleman.
I would remind all Members that the committee's
jurisdiction does not include any changes to the Affordable
Care Act, other than those involving transparency and
reporting, and that the committee's jurisdiction and its 29
hearings have been related not to whether we like the
Affordable Care Act or not, but, in fact, whether or not we are
getting the transparency, the proper reporting required, for
which this committee is known.
With that, I would have to ask Mr. Goldmann to please rise
to also take the oath. And raise your right hand, please.
Do you solemnly swear or affirm that the testimony you are
about to give will be the truth, the whole truth, and nothing
but the truth? Please be seated.
Let the record reflect that our third witness has answered
in the affirmative.
Dr. Gruber, it is now your turn. Thank you.
STATEMENT OF JONATHAN GRUBER, Ph.D.
Mr. Gruber. Chairman Issa, Ranking Member Cummings, and
distinguished Members of the committee, thank you for the
opportunity to testify voluntarily today. I am pleased to be
able to address some statements I have made regarding the
Affordable Care Act and the reaction to and interpretations of
those statements.
I am a professor of economics at MIT. I am not a politician
nor political advisor. Over the past decade, I have used an
economic micro-simulation model to help a number of States and
the Federal Government assess the impact of healthcare reform
on healthcare systems, Government budgets, and overall
economies.
I have had the privilege of working for both Democratic and
Republican administrations on healthcare reform efforts. I have
worked extensively with Governor Romney's Administration and
the Massachusetts legislature to model the impact of Governor
Romney's landmark health reform legislation.
I later served as a technical consultant to the U.S.
Department of Health and Human Services and provided similar
support to both the administration and to Congress through
economic micro-simulation modeling of the Affordable Care Act.
I did not draft Governor Romney's health plan, and I was
not the architect of President Obama's healthcare plan.
After the passage of the ACA, I made a series of speeches
endeavoring to explain the law's implications for the U.S.
healthcare system from the perspective of a trained economist.
Over the past few weeks, a number of videos have emerged
from these appearances. In excerpts of these videos, I am shown
making a series of glib, thoughtless, and sometimes downright
insulting comments.
I apologized for the first of these videos earlier, but the
ongoing attention paid to these videos has made me realize that
a fuller accounting is necessary.
I would like to begin by apologizing sincerely for the
offending comments that I have made. In some cases, I made
uninformed and glib comments about the political process behind
healthcare reform. I am not an expert on politics, and my tone
implied I was, which is wrong. In other cases, I simply made
mean and insulting comments, which are uncalled for in any
context.
I sincerely apologize for conjecturing with a tone of
expertise and for doing so in such a disparaging fashion. It is
never appropriate to make oneself seem more important or
smarter by demeaning others. I knew better. I know better. I am
embarrassed. And I am sorry.
In addition to apologizing for my unacceptable remarks, I
would like to clarify some misconceptions about the content and
context of my comments. Let me be very clear. I do not think
that the Affordable Care Act was passed in a non-transparent
fashion.
The issues I raised in my comments, such as redistribution
of risk through insurance market reform and the structure of
the Cadillac tax, were roundly debated before the law was
passed. Reasonable people can disagree about the merits of
these policies, but it is completely clear that these issues
were debated thoroughly during the drafting and passage of the
ACA.
I would also like to clarify some misperceptions about my
January 2012 remarks concerning the availability of tax credits
in States that did not set up their own health insurance
exchanges. The portion of these remarks that has received so
much attention lately omits a critical component of the context
in which I was speaking.
The point I believe I was making was about the possibility
that the Federal Government, for whatever reason, might not
create a Federal exchange. If that were to occur, and only in
that context, then the only way that States could guarantee
that their citizens would receive tax credits would be to set
up their own exchange.
I have a longstanding and well-documented belief that
health reform legislation, in general, and the ACA, in
particular, must include mechanisms for residents in all States
to obtain tax credits.
Indeed, my micro-simulation model for the ACA expressly
modeled for the citizens of all States to be eligible for tax
credits, whether served directly by a state exchange or by
Federal exchange.
I am not an elected official, nor am I a political advisor.
I am an economist who ran a complex micro-simulation model to
help Republican and Democratic politicians and their advisors
understand the impact that their policies would have on
healthcare systems.
The recent response to my comments at academic and other
conferences exceeds both their relevance and my role in
healthcare reform. I behaved badly and I will have to live with
that, but my own inexcusable arrogance is not a flaw in the
Affordable Care Act.
The ACA is a milestone accomplishment for our Nation that
has already provided millions of Americans with health
insurance. Our country's embarking on an exciting second open
enrollment period that will provide new opportunities for these
individuals and millions more to choose the insurance plan that
works best for them.
While I will continue to reflect on the causes of my own
insensitivity, I hope that our country can move past the
distraction of my misguided comments and focus on the enormous
opportunities this law provides.
Thank you.
[Prepared statement of Mr. Gruber follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you.
Mr. Goldmann.
STATEMENT OF ARI GOLDMANN
Mr. Goldmann. Thank you, Members, especially Chairman Issa
and Ranking Member Cummings, for inviting me to share my story
with you today.
I am one of the millions of Americans who, thanks to the
Affordable Care Act, have been able to pursue goals free from
the financial and physical implications of staggeringly
expensive health insurance or, in many cases, no coverage at
all.
These reforms have helped ensure that many Americans won't
have to weigh the crippling debt or something as simple as
nutritious food for their children against access to even the
most basic health care.
I hope that my words today serve as a reminder of why the
ACA, though imperfect, has measurably improved the well-being
of individuals and families across the country.
I grew up outside of Boston and stayed in New England for
college. My 20s were a decade of exploration and change. In
that decade, I had the freedom to switch careers twice,
experience love and heartbreak, and revel in excitement and
opportunity. At the same time, I watched friends become
burdened with unforeseen medical emergencies and forego access
to preventive care.
I am now 33 and have lived here in Washington, D.C., for 11
years. I am healthy. I have low cholesterol. I get plenty of
exercise. I am doing pretty well. When I turned 26, I decided
to abandon a nascent career in non-profit fund-raising, and
this decision was bolstered by the unbridled optimism of a 20-
something living in one of the most intellectually inspiring
cities in the world.
I didn't consider that, because I have two very common and
very manageable pre-existing conditions, I would be forced to
navigate an intimidating and unfriendly health insurance
marketplace.
As I formed a vision for my next career, I found great
satisfaction in making a living working in the restaurant
industry. Although I worked full-time then at a restaurant with
more than 50 employees, I was not offered any benefits.
Undeterred, I ventured out into the individual market and
applied to several brand-name companies. And one after another,
they turned me down.
Ultimately, one company offered me a plan at about $450 a
month, and, disheartened from the prior rejections, I enrolled,
even though they refused to cover any prescriptions or office
visits related to my pre-existing conditions. I conducted a
basic cost-benefit analysis and decided that I would rather be
underinsured than not insured at all.
My 2 years with this insurer felt like an unending, morbid,
exceedingly expensive joke. Claims were routinely rejected due
to processing errors, usually with no explanation. Still, it
was better than nothing. And then I received a notification
that, as of January 2014, my plan would be discontinued.
So I will admit that I wasn't looking forward to
participating or to going forward in the process of enrolling
through the D.C. healthcare exchange, as many other people can
agree with, probably. But despite all the technical glitches
and dead ends being reported by the media, I applied.
I contacted a navigator at the Whitman-Walker clinic, who
referred me to a broker, and he answered the many complex
questions I had about each individual policy that I was
considering.
With his help and at no cost to me, it took just under an
hour to sign up for a silver-level PPO plan. And in terms of
premiums alone, this reduced my costs by 60 percent, which
means I am saving over $200 each month, and I am able to keep
all of the providers with whom I have built trusting
relationships with over the years.
All my pre-existing conditions are covered. And over the
past year, I have had much lower day-to-day out-of-pocket costs
to manage my conditions. I estimate that I have saved more than
$5,000 in all, which, in addition to my part-time work as a
waiter, has made my decision to pursue my career as an
independent consultant more viable.
And I believe--and isn't that really quintessentially
American? I mean, thanks to the ACA, I am able to be
entrepreneurial and take control over my own future instead of
finding and staying at an undesirable job because I can't
afford to sacrifice my employee-sponsored health insurance. I
no longer feel marginalized. I no longer need to resort to
exorbitantly expensive, yet woefully inadequate, coverage.
And later this week--or--yeah--later this week, I have an
appointment with a broker to look into my options for 2015, and
I have the confidence that I will be able to shop for a plan
without fear of rejection or exclusion for coverage. I can do
the research to find a plan that will meet my needs.
So, finally, when my old plan was canceled, I thought I was
going to get similar coverage at the same cost and I didn't
expect it to be as good as it was. The unexpected thrill, I
felt, after I enrolled was not only because I am covered, but
also because I am participating in a part of history.
And at the end of day, I am an ordinary man with a pretty
good education and from a healthy family. So if the
Affordable--if the Affordable Care Act--excuse me--can help me,
I believe it can help anyone.
Thank you very much for your time.
[Prepared statement of Mr. Goldmann follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you.
Mr. Goldmann, are you receiving a subsidy at all on that--
that silver plan you chose?
Mr. Goldmann. No, I am not.
Chairman Issa. Okay. Well--and I am glad you found part-
time work even though, in the past, you have found full-time
work.
Ms. Tavenner, you testified before the committee and you
used the terminology ``enrolled in the healthcare insurance
market coverage.''
Is that the appropriate normal way you have always referred
to enrollment numbers?
Ms. Tavenner. I don't know that I have an appropriate. I
have called it ``the marketplace.'' I have called it ``health
insurance coverage.''
Chairman Issa. Well, that language allowed you to claim 7.3
million.
Had you said ``enrolled in healthcare plans,'' you would
have had to reduce that by at least 400,000. Isn't that true?
Ms. Tavenner. I think, had I known that we had double-
counted the dental, I would have corrected that for the
September hearing. As I said before, that was a mistake and----
Chairman Issa. Well, no. I am not asking questions about
the mistake.
You gave what would be considered by anyone to be false and
misleading testimony because you were given data that included
400,000 dental plans.
CMS had previously released separate numbers--actually, far
greater numbers for dental at the time and health care, and, as
those numbers went down, they got combined and the language got
changed to ``enrolled in the health insurance marketplace
coverage.''
So the question is: Did you have anything to do with the
use of that term? And were you aware--and it is a two-part
question; each is a yes or no--were you aware that dental was
included in your testimony?
Ms. Tavenner. I was not aware that dental was included in
my testimony.
Chairman Issa. And were you in any way explained why the
use of ``enrolled in the health insurance marketplace
coverage'' was the term you read in your statement?
Ms. Tavenner. No. But----
Chairman Issa. Thank you.
Mr. Gruber, I have been accused that I am going to berate
you or something, and I hope that you won't feel that way when
I get done.
But the night before last I was at the Kennedy Center
Honors, where they honored Tom Hanks, famously, Forrest Gump,
the ultimate in successful stupid man.
Are you stupid?
Mr. Gruber. I don't think so. No.
Chairman Issa. Does MIT employ stupid people?
Mr. Gruber. Not to my knowledge.
Chairman Issa. Okay. So you are a smart man who said some--
as the ranking member said, some really stupid things. And you
said the same. Is that correct?
Mr. Gruber. I--the comments I made were really inexcusable.
Chairman Issa. Okay. And I will leave aside the political
observations.
But you did say in your--in the video we played--and
everyone else has seen, I think, parts of it--you did say that,
in fact, if people knew the whole truth, they wouldn't have
voted for this, that, in fact, the direction you were going,
the reality--and, specifically, I want to talk--because Mr.
Goldmann's a poster child for this. He has a silver plan that
is relatively inexpensive. If it was subsidized, it would be
even cheaper.
But the shifting of some people to pay more than they
previously did--because, remember, health care went up in
price. So for Mr. Goldmann to get a reduction, somebody else
got not only an increase, but an increase to offset his
decrease. That was what you were talking about.
So isn't it true that, in fact, between the taxes and
increases for some, that is part of the plan, to reduce for
people like Mr. Goldmann?
Mr. Gruber. The--first of all, I made a critical mistake in
trying to conjecture with a tone of expertise----
Chairman Issa. Yeah.
But you are an expert on the analysis of the numbers and
where the cost-shifting goes in your micro-economic analysis.
And I am asking you as Dr. Gruber, a smart man, a smart man at
a great institution that has collected over 400--or, actually,
over $4 million in various fees and so on.
Your analysis--isn't it true that, in order for Mr.
Goldmann to get his reduction--and he is very happy about it--
that, in fact, it was cost-shifting, including those so-called
Cadillac plans? Isn't that true?
Mr. Gruber. The Affordable Care Act set up insurance
exchanges which pooled risks for the healthy and the less
healthy. On average, when you account for the tax credits
individuals received, people are paying less for health
insurance than they----
Chairman Issa. I am a taxpayer, Mr. Gruber. Trust me,
people are not paying less. People like me are paying more for
those because taxes are, in fact, a cost that is paid.
Total cost did not go down. Cost-shifting occurred in your
model. Isn't that true?
Mr. Gruber. The amount that individuals have to pay for
health insurance, on average, fell in my model.
Chairman Issa. Well, but it didn't fall in reality.
Now, let me just ask one question. And this may be the
tougher question for you. You said in these video comments
that, essentially, you had to deceive in order to get this
passed.
Your models, the 4 million-plus dollars that you and MIT
received, including hundreds of thousands of dollars
personally, to develop and to provide those models, if
deception was part of the process by your own statements, why
should we believe your analysis? Why should we not demand to go
into the micro-economic analysis and find out whether, in fact,
the $4 million in services you delivered were accurate or
whether the books were cooked?
Mr. Gruber. First of all, the amount of money to which you
refer has been greatly overstated. It refers to grants that
were received by research institutions and others, which I
received a small fraction.
Second of all, no one has ever questioned the quality or
integrity of the modeling. The fact I made----
Chairman Issa. Mr. Gruber, I am questioning it in light of
your statements, and that is why I am asking.
Shouldn't we question or at least have independent analysis
of the numbers you delivered before--actually, to
Massachusetts, for that matter, too--but to the Federal
Government based on your statements that, in fact, if people
knew the truth, they wouldn't and that there was a deception in
your own thing?
And it is--all I want--I want to go to the ranking member.
But is there any reason that you would not approve of the
idea that there should be independent validation of the numbers
you used in light of the statements that we have seen you made?
Mr. Gruber. I think that the quality of my numbers should
not be reflected by comments I made where I was conjecturing
outside my area of expertise.
At the same time, my modeling has always been very
transparent. There's--I have posted information about my model,
and I am happy for you to ask questions about the model--
answer questions about the model and how it works.
Chairman Issa. Thank you.
I hope that this committee and the next Congress will
insist that there be an independent analysis of whether, in
fact, that model would withstand the scrutiny of an audit.
With that, I recognize the ranking member.
Mr. Cummings. Well, thank you, Mr. Chairman.
Dr. Gruber, as I mentioned in my opening statement, I was
very frustrated when--with your statements, and I have got to
tell you they were insulting. They were especially harmful
because they gave the opponents of the ACA a PR gift. Man, you
did--you did a great job. You wrapped it up with a bow.
This has nothing to do with the substance of this issue. It
is just something critics will link to the ACA in future
debates.
Now, I have to say I listened very carefully to your
testimony because I wanted to hear exactly what you were going
to say. A lot of times witnesses who come before the committee
spin and avoid apologizing; so, you deserve some credit at
least for taking this head on and taking responsibility for
your actions.
I know you believe in the ACA and you also worked with
Governor Romney on his healthcare bill. Is that right?
Mr. Gruber. Yes.
Mr. Cummings. So my question is this: Sitting here today,
what do you say to those people who are trying to eliminate the
ACA and who are quoting your statements as a reason to repeal
health care for millions of Americans and many of my
constituents and people watching us right now on C-SPAN? Now,
what do you say to them?
Mr. Gruber. I would say that I made a series of inexcusable
and offensive comments where I conjectured with a tone of
expertise to try to make myself seem smarter by demeaning
others and I apologize for that, but that my flaws as a private
citizen, not a politician, not a political advisor--my flaws,
as a private citizen, should not reflect on either the process
by which the ACA was passed or the success of that law itself.
Mr. Cummings. Now, Administrator Tavenner, you have been
before our committee before. And I have complimented you on
your efforts, and I do still believe that you are a great
public servant.
On November 20, HHS reported that it had overstated the
numbers of enrollees by about 380,000. The chairman talked
about that in his opening statement and he just asked you about
it. This was because HHS included people with dental coverage,
too, and essentially double-counted them.
How could you--how could that happen? I mean, you knew
everybody--they know everybody's got a microscope on the
program. So I am just curious.
Ms. Tavenner. So it is a great question.
It was an inexcusable mistake. And I think, in looking at
payments made instead of unique individuals, we counted
individuals who had both medical and dental.
I believe we have put processes in place to prevent that
from happening again, but it should not have happened the first
time.
Mr. Cummings. But you understand that the mistake has the
same effect as Dr. Gruber's statements. Same thing. It gives
ACA opponents a PR gift that they can use on cable shows and
elsewhere to attack the ACC, and it is an unforced political
error.
So now I have to ask you for the record--because
everybody's going to ask you the same thing. You are under
oath. And just tell me: Did you intend to deceive this
committee or the American people when you provided those
enrollment numbers? Was that your intention?
Ms. Tavenner. I did not.
Mr. Cummings. And do you have any reason to believe that
anyone on your staff tried to deceive the American people or
was this error inadvertent?
Ms. Tavenner. I do not believe anyone tried to deceive the
American people, and I believe the error was inadvertent.
6.7 million is a very large number. We are pleased with
that number. This was an inadvertent mistake, for which I
apologize.
Mr. Cummings. As a result of the--now, Mr. Goldmann, I want
to thank you for being here today. And I am glad you are
working, and I am glad you are pursuing your dreams. And that
is a good thing.
As a result of the ACA, it is a fact that insurance
companies can no longer discriminate against people like you,
deny you coverage or charge exorbitant rates because of your
pre-existing conditions.
How do you feel about that? And I think it is important for
people to know what that means. You know, we hear a lot of
times the negative stuff, particularly in this committee, but
it is good to have somebody who has benefited from this. Can
you tell us how that makes you feel.
Mr. Goldmann. Right. I--this isn't something I had thought
about before--all this, before I really left an employer that
gave me benefits because it wasn't something I--I thought was
an issue. And I think I took that for granted, and I think a
lot of people take that for granted.
The healthcare coverage I had growing up and as a young
adult in my 20s was great. And then, when I decided to pursue
something different, something of my own making, something very
typically American, and I no longer had coverage, I--it came as
a shock.
So to suddenly have that inability to have my own little
pre-existing conditions that many people have not be covered
was--was a very strange and unusual feeling to me, and it was
not a good one.
So--so to be able to enroll through the ACA and to still
pay my part, but to know that I am not being discriminated
against based on something that millions of Americans have--it
doesn't matter what they are particularly--it was a relief.
And I didn't realize how much of a relief it would be until
I actually got enrolled with a good healthcare provider as
opposed to someone--or a provider that provided inadequate
benefits.
Mr. Cummings. This is the last question: What was wrong
with your insurance before you got this insurance here? You had
previous insurance. Is that right? Did you have----
Mr. Goldmann. Yes. My preceding insurance.
Mr. Cummings. Yes.
Mr. Goldmann. Yes. Well, the premiums were almost twice as
high, which in itself, it is a--you know, it is a supply-demand
issue, I assume. I am not an economist, unfortunately,
although, I can make guesses.
But I will say that the coverage I had, despite--regardless
of how much I was paying on a monthly premium, was insultingly
inadequate and not just because of what it wouldn't cover, but
because of how difficult it was to process claims and how
difficult it was to get any sort of response from the company
itself.
So, yes, prescriptions and doc--office visits related to my
pre-existing conditions were uncovered, and that required a lot
of out-of-pocket benefits. But, also, even the stuff that was
covered was very difficult to get reimbursed for.
Mr. Cummings. Thank you, Mr. Chairman.
Chairman Issa. Thank you.
And with the ranking member's indulgence, Ms. Tavenner, I
failed to only ask one thing. Can your staff provide any of the
information related to those--the preparation of those talking
points that was in the subpoena? That was part of what was
asked for and not delivered.
Ms. Tavenner. So we will--I know that we supplied some
information to you late yesterday evening. I will go back and
work with the staff to see what else we can get you. We are
trying to work with you.
Chairman Issa. Well, the discovery asked for information
related to the false statement that was made by you, certainly
inadvertently. You have called it a mistake.
But we asked for the creation of it so we could see who
created it, who put the numbers together. You know, it took a
staffer 20 minutes to find the error once we got the passwords
to unlock this. It wasn't hard to find.
So the question is--and I will be brief--can you ask your
people, to the extent that it has already been pulled--and we
believe, if we issue a subpoena, it has already been pulled.
Our people worked with your people. They knew this is what we
wanted--could we have it?
Because we have people on both sides of the dais who don't
have those facts at what would be the last hearing of this
year. So I appreciate that you want to get it to us in the
future.
But it is crippling to a great extent to have a hearing in
which the main subject of the hearing, which is, how did we get
misled and who was involved in the process of creating those
talking points--we don't have it.
So the question is: Can you instruct your people, to the
extent that there has been any pulling of those documents, to
get it over to us so that people down the dais can ask those
questions? I know Mr. Gowdy likes working off of facts, not
fiction.
Ms. Tavenner. Yes, sir. We will work with you.
Chairman Issa. Thank you.
Mr. Cummings. Mr. Chairman.
Chairman Issa. Yes. Mr. Cummings.
Mr. Cummings. Just 30 seconds.
Mr. Chairman, one thing I failed to say--I wanted to--when
I was complimenting you earlier----
Chairman Issa. You are not taking any of that back, are
you?
Mr. Cummings. Oh, no, no, no, no.
I wanted to take a moment, Mr. Chairman, to express my deep
appreciation and respect for your staff and for my staff.
I know a lot of people will be moving on to new jobs, but
these are folks that work night and day trying to present the
very best that they can to this committee and to the American
people, and I want to take a moment to thank them for all that
they have done. This is a key time in American history. And I
appreciate it. Thank you.
Chairman Issa. Well, thank you.
And because of your wise comments, I am going to pile on
just in one sense, Mr. Cummings.
We do have the best staffs on the Hill. They do countless
thousands of hours of deposition and transcribed interviews.
They pore over more documents than any other committee of the
Congress, and they are able to qualitatively search for and
find in IG reports, in Freedom of Information reports, and,
obviously, in working with whistleblowers, things that no other
committee can find.
And I think that that is a genuine statement for both
sides. There is no better set of committee staff than what we--
we are honored to have. And I thank you for bringing that up.
We now go to the gentleman from Ohio, Mr. Turner.
Mr. Turner. Thank you, Mr. Chairman.
Mr. Gruber, you have said that your statements were
inexcusable and insulting. I certainly understand, when someone
gets caught saying something as inflammatory as what you have
said, how you might want to recant it.
However, some of the things you said were substantive-
based, and although they may be inexcusable and insulting in
that they were said, in the end, they may be true. And I want
to walk you through some of the statements that you made that
were substantive in nature rather than the statements that you
made about the American voter.
Now, you said that you did complex micro-simulation
modeling. It sounds like a relatively basic model to me. You
take from one and give to another. It is a basic equation of
wealth redistribution, and that is called a tax. And you have
made many statements about the Obamacare plan as being a tax,
and I want to go through those.
Now, I want to remind you this is not the casual
conversation that you have had in the conferences where you
have insulted the American voter. This is actually a hearing
where you took an oath.
You said, on March 16, 2011: The only way we could take it
on was first by mislabeling it, calling it a tax on insurance
plans rather than a tax on people, and we all know it is really
a tax on people who hold those insurance plans. A tax.
On January 18, you said: If you are a State and you don't
set up an exchange, that means your citizens don't get the tax
credits, but your citizens will pay the taxes that support the
bill. A tax.
October 30, 2012, you said: We just tax the insurance
companies. They pass it on in higher prices that offset the tax
breaks we get. It is very clear, you know. And that is when you
went on and insulted the American voter as to the fact that
they couldn't understand that basic equation.
And then, on October 17, you said: This bill was written in
a tortured way to make sure CBO did not score the mandate as
taxes. If CBO scored the mandate as taxes, the bill dies.
Now, I know, Mr. Gruber, that you believe that your
statements were inexcusable and insulting, but they do appear
to be true.
You are not hear recanting today your statements with
respect to the tax aspect of Obamacare, are you?
Mr. Gruber. I am here to today to say that any conjectures
I made about political processes----
Mr. Turner. This is not a conjecture, Mr. Gruber. I mean,
conjecture is, ``I believe it may have been,'' ``Someone may
have been thinking,'' ``Perhaps they were,'' ``Perhaps it
was.'' This is your straight-up statements. These are not
conjecture.
Is it your purpose today to recant Obamacare as a tax?
Mr. Gruber. It is my purpose today to come forward and
elaborate and straighten out the interpretation of a series of
comments that I made and to apologize----
Mr. Turner. Excellent. Let's do that, then. Let's clarify
it.
Mr. Gruber, you made these statements, did you not?
Mr. Gruber. If--I don't recall exactly, but----
Mr. Turner. You don't recall. Now, one of them we actually
saw on video. Do you recall that one?
Mr. Gruber. Yeah.
Mr. Turner. Well, these statements--we'll enter them for
the record--and I can't imagine how you don't recall your own
statements, because the American voter has seen them over and
over again as you've called them stupid. Do you deny making
these statements, Mr. Gruber, even though you don't recall
them? Do you deny calling Obamacare a tax?
Mr. Gruber. If you're reading my actual quotes, then I
don't deny it. I don't have----
Mr. Turner. I am reading your actual quotes.
Mr. Gruber. Then I don't deny it.
Mr. Turner. Okay. So you're not here to recant it or to
deny it.
Mr. Gruber. I am here to explain that a number of those
comments were made in a tone of expertise that I don't have
when I was talking about political----
Mr. Turner. Mr. Gruber, do you know what tax is? I mean,
you do have, you now, expertise in economics. Do you know what
a tax is?
Mr. Gruber. Yes.
Mr. Turner. Okay. So you would not deny today that in these
statements that you made that Obamacare is a tax, would you?
Mr. Gruber. Obamacare is a large piece of legislation with
many parts.
Mr. Turner. And one of those parts a tax, Mr. Gruber.
Mr. Gruber. There are some taxes in Obamacare, yes.
Mr. Turner. Well, the President, as you know, argued that
Obamacare was not a tax until it went before the U.S. Supreme
Court as to whether or not Obamacare was a tax. And then the
administration argued that it is a tax in order to be able to
save it from being declared unconstitutional.
So I would assume that you agree with the U.S. Supreme
Court that Obamacare provisions include taxes. Right?
Mr. Gruber. The U.S. Supreme Court ruled on a particular
provision of Obamacare----
Mr. Turner. You do not disagree with them, do you?
Mr. Gruber. I'm sorry?
Mr. Turner. I said, you don't disagree with them that there
are elements of Obamacare that constitute a tax.
Mr. Gruber. I don't agree with their conclusion about the
mandate.
Mr. Turner. Excellent. Interesting. Different than what you
said at these hearings.
But now I have a question for you that I'd like you to
think back. You said, I mean, this bill was written in a
tortured way to make sure CBO did not score the individual
mandate as taxes.
Did you ever speak to anyone in the administration who
acknowledged that to you or that explained that to you or who
assigned a problem with you with a construct of that we have to
draft this in a tortured way so that we make sure CBO did not
score the individual mandate as taxes. And you are under oath,
Mr. Gruber. Did anybody in the administration have that
conversation with you?
Mr. Gruber. That was an inexcusable term used by----
Mr. Turner. I'm not asking you about how you believe that--
whether or not you should have said that or not. It's a factual
statement you're making. Did anybody in the administration ever
have that conversation with you?
Mr. Gruber. I do not recall anyone using the word
``tortured,'' no.
Mr. Turner. Did they have the conversation with you that it
had to be drafted in a way that the CBO did not score the
individual mandate as taxes? Anyone in the administration
acknowledge it, explain it, or assign aspects to you within
that construct.
Mr. Gruber. I don't know.
Mr. Turner. You are under oath.
Mr. Gruber. I honestly do not recall.
Mr. Turner. Mr. Chairman, thank you.
Chairman Issa. Thank you.
We now go to the gentlelady from New York, Ms. Maloney.
Mrs. Maloney. Thank you. Thank you. I want to remind my
colleagues that passage of the Affordable Care Act was, in
fact, an open and extremely transparent process. We had here in
the House over 79 hearings, almost 100 hours of hearings.
And, prior to the Affordable Care Act, we have to remember
that there were roughly 48 million Americans, including 2.6
million New Yorkers, who were uninsured. And there is even more
good news coming out of New York where insurance rates for
individuals are more than 50 percent lower than they were
before the State's marketplace plan began.
And I want to say that there have been many reports that
have said that the ACC contributed to the slow growth rates in
national health expenditures over the past few years. The
recent report from the National Health Expenditure Report
showed that spending grew by just 3.6 percent in 2013, and that
was the lowest rate of growth since 1960.
So that is all good news for the American people.
Dr. Gruber, I'd like to ask you, do you support the
Affordable Healthcare Plan? Do you believe that it is sound
public policy that helps people?
Mr. Gruber. Yes, I do.
Mrs. Maloney. And, Administrator Tavenner, I represent a
large number of hospitals. And I understand that, because of
the Affordable Care Act, hospitals are projected to save $5.7
billion in uncompensated care costs this year alone.
How has the ACA helped to save hospitals money and
incentivize effective patient care?
Ms. Tavenner. I think the ACA has worked in a couple ways.
Obviously, to increase the number of uninsured helps hospitals
from the standpoint of their bad debt and other--particularly
in rural America, where they are very reliant on the number of
insured and small-volume markets, particularly. So I think
that's the first area.
The second area is we've made a point of tying payment to
quality. So, as you know, we are paying related to whether it
is hospital-acquired conditions, readmissions. We're actually
having hospitals report their quality instead of paying purely
for volume or for procedure.
So I think those are two of the ways that it's helped. And
I think hospitals in general are reporting, particularly on the
for-profit side, better earnings as a result of some of these
changes.
Mrs. Maloney. Well, many people have commented on the fact
that we have the lowest rate of growth in healthcare costs
since 1960. Can you elaborate on how the ACA is slowing down
these costs? How is that happening? What is contributing to it
in the past few years?
Ms. Tavenner. If you look at, going back to the hospital
issue, we have certainly seen it in terms of number of
admissions and readmissions to hospitals. The hospitals have--
growth rate has been flat almost to the point of being
negative. On the outpatient side, we've seen it in some of the
growth rates around physicians, physician visits. I think in
almost every area, except pharmaceutical, we've seen a slowing
in what has been the normal health expenditure rate.
Mrs. Maloney. And could you comment on the Affordable Care
Act's payment and delivery reforms and give an explanation?
Many people attribute that as a factor in lowering costs.
Ms. Tavenner. Yes. I think the biggest point that we have
been able to do, starting first with hospitals and now we've
expanded it to physician and other Part B settings, whether
it's skilled nursing facilities or home health or otherwise,
has been to move from a per-procedure or a volume-oriented
payment to a payment that's tied to quality and outcome
measures. I think that has been the biggest change.
Mrs. Maloney. Are the Affordable Care Act reforms an
important contributing factor in improvements that have been
reported in adverse drug events, falls, other complications, as
well as a fall of 8 percent in readmission rates for Medicare
patients?
Ms. Tavenner. Yes, it has been. Certainly, there is more
work to do and we'll continue to do work through the Innovation
Center and through the Medicare area and Medicaid as well.
Mrs. Maloney. Do you believe that these reforms in Medicare
to cut costs and improve quality are having a spill-over effect
throughout the entire healthcare system? And, if so, how?
Ms. Tavenner. Yes. In fact, we actually work closely with--
we try to align Medicare, Medicaid, and the private insurance
market. And we work closely with issuers to make sure that
physicians and hospitals are working from one set of quality
criteria. So we are trying to work together.
Mrs. Maloney. Well, I think this is all good news for the
American consumer and for healthcare in our country.
Ms. Tavenner. Thank you.
Chairman Issa. With that, we go to the gentleman from
Florida, Mr. Mica.
Mr. Mica. Thank you, Mr. Chairman. Thank you also for your
service great job on this committee and it is a tough task.
Ms. Tavenner, when we started all of this we had I
thought--I heard between 44 and 45 million people that were
uninsured. That was just a general figure I heard. Is that what
you would estimate?
Ms. Tavenner. I don't have that number in front of me.
Mr. Mica. Well, okay. You should have the number,
particularly in your position. But we'll just say 44. I'll take
the lower number.
Ms. Tavenner. All right.
Mr. Mica. Now, you came and you gave us some statistics
last May: 7.3 million signed up. And then that was revised. And
you apologized today for the error that you--at least you claim
it. That's 6.9 million people, approximately.
There are somewhere between 4 and 5 million people who had
insurance before we had Obamacare that lost their insurance
coverage. That's the estimate I have heard. Would you agree
with that?
Ms. Tavenner. I don't know that number.
Mr. Mica. Okay. Well, again, I think you should because
this is important.
The whole thing is, how many people are we covering? If we
have 44 million and you had 4 or 5 million people that were
insured--I'm one of the people. I--one reason you probably
don't have more admissions is my deductible is three times as
much. My premiums have gone up. The premiums I would say for
most Americans listening or participating have gone up. Unless
you're involved in some other healthcare system, your premiums
have gone up. We've seen an exception. I have family who have
had preexisting condition, and actually, I have seen what they
are doing; they are gaming the system. They get the service,
and then they drop the care.
So that's--that's also gone down. Gone down as far as
admissions. One reason for less admissions and less spending.
Dr. Gruber, you're one of the architects of this plan.
Mr. Gruber. I was an economic----
Mr. Mica. Modeling? You did the modeling? You were a
contractor?
Mr. Gruber. Yes.
Mr. Mica. One of, I understand, about 60 contractors. What
did you--what was your payment for your contract work with the
HHS?
Mr. Gruber. I was paid somewhat less than $400,000.
Mr. Mica. $400,000.
And I heard that was are a sole-source contract, too. Nice
way to go. Was that a sole source?
Mr. Gruber. I don't exactly know.
Mr. Mica. Well, did you compete, or did you have--you got a
sole-source contract, I'm told. Okay. I'll leave it at that.
You got a sole-source contract, according to the information I
have. Nice way to go.
The other thing is then you went out to about the eight
States. Did you have contracts with a number of States
afterwards?
Mr. Gruber. Yes, I worked with a number of States
afterward.
Mr. Mica. And I heard you got between 200,000 and 400,000 a
pop from them.
My estimate that I have been told by staff is you took down
about $2.5 million in this.
Mr. Gruber. The number----
Mr. Mica. All the money from healthcare from your
involvement, again, about eight States. Am I right?
Mr. Gruber. I don't recall the exact number of States.
Mr. Mica. You can't recall. Well, again, I think it would
be helpful if you could supply the committee the amount of
money, and I'm told it's over $2.5 million.
You're just one of the vendors. Some of them had contracts
for more than a billion dollars.
But the whole thing gets back to people that we have that
are still uninsured. We have, according to the documents I got,
41 million people still don't have health care. Would you agree
with that number?
Ms. Tavenner. I don't know which document you're referring
to.
Mr. Mica. The latest--the document that we had presented to
us says 41 million Americans still don't have health care. So
we've covered somewhere between 3 and 4 million at billions of
dollars of costs, raise most people's premiums.
Ms. Tavenner. I think if you look at it, outside sources,
they would tell you that the uninsured rate for adults has got
down 26 percent.
Mr. Mica. We have over 40 million people without health
insurance. This isn't a success in my estimation. I'd like to
get and divide the billions of dollars we've spent on this
program, the consultants who took advantage of it and enriched
themselves, and we still have 40-some million people.
And we can address preexisting conditions, Mr. Goldmann,
and, Ms. Tavenner, Dr. Gruber. We can also increase the age to
26 for coverage, some of the things that were done--and
positive things that I think needed to be done.
But do we need the bureaucracy? Do we need the people who
have fed off the public trough in billions of dollars?
One of the contractors that I looked at in a previous
hearing had gotten a contract for over a billion dollars, and
people supposedly came to work on verifying information and
never--never worked. So people were paid not to work.
People were paid to help design the system and then
profited and took the money away. To me, that's not a very good
story.
Yield back the balance.
Chairman Issa. I thank the gentleman.
Mr. Gruber, when you signed your Truth In Testimony form,
you used--used an Exhibit B and you didn't use our form we
provided. As a result, we don't have that revenue, which is--
the State revenue is essentially Federal revenue. We provided
grants.
So would you agree to supplement your Exhibit B so that we
would have on your Truth In Testimony, your State revenue that
would have also--you would have also received since ultimately
it's Affordable-Care-Act related.
Mr. Gruber. I'm sure my counsel will be happy to take that
up with you.
Chairman Issa. Actually, I was asking would you agree to
provide it?
Mr. Gruber. As I said, I'm sure that's something you can
discuss with my counsel.
Chairman Issa. So you're not agreeing to provide it.
Mr. Gruber. I'm not agreeing or disagreeing; I'm saying
that's something that I'm not expert on----
Chairman Issa. Would you confer with your counsel, please?
It's a requirement before you testify. And as we reviewed your
Exhibit B, because you didn't use our form and go down it, we
don't have all of your income. Since that's become a factor
here, would you please--we'll take a moment. We'll take just a
short break. Provide with your counsel to see whether you can
affirmatively answer that.
Mr. Gruber. My counsel has informed me that my disclosure
is in compliance with the House Committee Rules. And if there's
any additional questions, he'd be happy to answer them.
Chairman Issa. Okay. We'll----
Mr. Mica. Mr. Chairman, could I request, then, that the
witness provide the committee with the amount of money received
from the Federal Government and any other healthcare payments
that he received since the beginning----
Chairman Issa. Apologize. This is a technical rule of the
committee, folks. The gentleman asked a question.
Mr. Mica. It is a simple request. Can he provide us that?
Mr. Gruber. Once again, I--the committee is welcome to work
with my counsel on that.
Mr. Jordan. Mr. Chairman?
Chairman Issa. Mr. Jordan.
Mr. Jordan. Why doesn't he just tell us? How much money did
you get from the State taxpayers and the Federal taxpayers?
He's under oath. Why doesn't he tell us how much he got paid by
the taxpayers?
Ms. Norton. Does he have the time?
Mr. Jordan. We don't have to wait for him to send something
to us. He should just be able to tell us, how much did the
taxpayers pay him?
Mr. Mica. Again, we have a witness under oath.
Chairman Issa. Okay. I'm going to go on to other
questioning, and we will see what we can get as a further
determination.
But it is--it is at this point, I am being advised, that
this--this is not an accurate and full disclosure. So we do
disagree with your counsel's interpretation.
Mr. Cummings. Mr. Chairman.
Chairman Issa. Mr. Cummings. Of course.
Mr. Cummings. Just one thing. Maybe, Mr. Chairman, during
the course of this hearing, you can confer with counsel at some
point.
Chairman Issa. That's what I want to do. I want to go on
with the hearing, and we'll try to do this behind the scenes.
Because I don't want to delay the hearing for what has proven
to be--and, Mr. Mica, I will seek additional time for you if we
can get the information.
Mr. Cummings. Thank you, Mr. Chairman.
Chairman Issa. Ms. Norton is recognized for 5 minutes.
Ms. Norton. I want to thank you, Mr. Chairman, again, for
your friendship, for your service, and for the respect you have
shown for the American citizens who live in the District of
Columbia who demand to be treated as free and equal Americans,
and you have always done that. Appreciate your work on this
committee, very difficult committee, and I sympathize.
Dr. Gruber, I accept your apology. I'm not going to
question you further. Your statements invite acts of
demagoguery. You will hear enough of those. I decline to
participate.
Ms. Tavenner, the $400,000 difference, $400,000 difference,
is trumpeted as if it were words hiding those smaller amounts
when the Affordable Healthcare Act greatly exceeded our
expectations in the numbers that would sign up.
So all I can say is if the administration was going to
fudge it, I certainly hope they would not have been so
amateurish. And I think the American people will understand how
one could confuse people who signed up for dental care as
you're just looking at people who signed up and people who
signed up, period. Because those were not the distinctions we
were looking for at the time.
Mr. Goldmann, you are a constituent of mine. I appreciate
that you stepped forward. I do want to say to you the chairman
said something about cost-sharing in his preface to questioning
you. But you had testified that you were not being subsidized.
Mr. Goldmann. That's correct.
Ms. Norton. If that is the case, you are like millions of
other young people who got lower-cost insurance simply because
you are young and not because any costs were shifted to you.
That is the very nature of insurance.
Now, I would like to ask, I note, Ms. Tavenner, that this
hearing is taking place when we are early in the new enrollment
system--enrollment period, I'm sorry-- and I thank you for
coming at such a busy time.
You had a deputy, the principal deputy administrator--I'm
sorry--not your deputy, but the principal deputy administrator
is quoted as saying, ``The vast majority of shoppers had a
positive experience with healthcare.gov.''
Is that your understanding? If so, that needs to be out
here, given the faux pas of the first few months.
Ms. Tavenner. Yes, ma'am. Our second enrollment period has
been much smoother, obviously. But we have been able to talk
with some consumers. We have also been able to meet weekly with
issuers to ask them what they are seeing from a consumer
perspective as well. And so far, the enrollment process has
been easy, by folks' terms. I'm sure it's not perfect. We still
have room for improvements.
Ms. Norton. So you are doing the kinds of customer--that
you can quantify, customer experience that you can quantify as
to what the experience has been so you will be able to say that
at the end of this period.
Ms. Tavenner. We are. It's a little early, because,
obviously, we are just 3 weeks in. But we are doing surveys,
both through the call center and surveys through
healthcare.gov----
Ms. Norton. That will be very important because you had
such a poor start.
Ms. Tavenner. We will share that information.
Ms. Norton. Now, I understand that you can now handle
quarter of a million concurrent users. Is that the case?
Ms. Tavenner. Yes. In our testing, we--that is what we
aspire to, and we were able to do end-to-end testing to handle
that type of volume, yes.
Ms. Norton. I have some numbers here that open enrollment
in 2014, more than 1.5 billion Americans submitted applications
for coverage. And that 765,135 individuals selected a plan.
How does that compare, if you have any figures, with the
first few weeks of open enrollment in 2013?
Ms. Tavenner. Well, as you might remember, in the first few
weeks, we were dealing with a Web site that was far from ideal,
so our numbers were very low.
We are pleased with the numbers in the first 3 weeks. But I
think we know by 1 year's experience, that individuals will
wait until deadlines to sign up. So we are looking for----
Ms. Norton. And what is that deadline, Ms. Tavenner?
Ms. Tavenner. The first deadline is December 15. So this
coming weekend we think we will be high volume. And then,
again, February 15 when open enrollment closes for 2015.
Ms. Norton. I would like, in light of how easy it is to
make--to make errors, that you will then be called on, in
September, you testified before this committee and you pledged
to address at that time 22 technical recommendations that the
GAO had made to improve of the security of the Web site, and
that is always a concern.
Were these 22 recommendations addressed before the
beginning of open enrollment this year?
Ms. Tavenner. Yes, they were. We completed our work on all
22 of those recommendations. And then there were six other
categories that we have completed the work in that area.
Probably the only thing that is not totally complete is the
operating agreement with the--with OPM and with the Peace
Corps. We have a contractual agreement, but we were going
through a full contracting process, and that's underway
Chairman Issa. I think the gentlelady's time has expired.
We now go to Mr. Jordan.
Mr. Jordan. Thank you, Mr. Chairman.
The ranking member said that these are just mistakes; they
are just unforced errors. I think the American people would say
something completely different. I would say, no, these aren't
mistakes, unforced errors. This is intentional deception, and
it's nothing new. ``If you like your plan, you can keep your
plan.'' ``If you like your doctor, you can keep your Doctor.''
``Premiums are going to go down.'' ``Premiums are going to go
down $2,500 on average.'' ``The Web site will work.'' ``The Web
site's secured.'' CMS, Ms. Tavenner, tells us they have
7.3million enrollees; they forgot to count 400,000 dental plans
in that number.
And then we get to Mr. Gruber. Mr. Gruber testified before
Congress about Obamacare and didn't disclose that he was being
paid by the Obama administration. That's deception at its
highest form. And then, of course, we have the videos, the now
famous videos where Mr. Gruber used taxpayer dollars to deceive
taxpayers. And then when Obamacare became law, he made fun of
them and insulted them.
By the way, Mr. Gruber, back to the question we had a
little discussion on earlier: How much were you paid, you and
your institution, by the Federal taxpayer and by the State
taxpayer, regarding your lectures on Obamacare?
Mr. Gruber. I have disclosed for the committee. As I
understand, my counsel, I'm required Federal payments----
Mr. Jordan. I'm not asking what you disclosed. I'm asking
you a question. Give me a dollar amount. How much were you
paid? The American taxpayer would like to know how much they
paid you to deceive them and then got made fun of by the very
dollars that they paid you to make fun of. They'd like to know
that. So how much were you paid?
Mr. Gruber. As I said, the committee can take that up with
my counsel.
Mr. Jordan. So you're not going to answer the question.
You're under oath. We're asking you a simple question. You come
to the committee; we ask a question; you're supposed to answer
the question. How much were you paid by the Federal taxpayer
and the State taxpayer?
Mr. Gruber. As I said, the committee can take that up with
my counsel. Would be happy to provide whatever----
Mr. Jordan. All right. I've got one other question.
Chairman Issa. Would the gentleman suspend for a moment?
Mr. Jordan. If you keep my time on.
Chairman Issa. Yes. I want to advise everyone that counsel
had said that they are not available to clear up the errors and
omissions in the gentleman's truth filing. It does require--our
form does require grants, contracts. In other words, we cover
all revenue. We only received about $100,000, which is far less
than the gentleman's testimony, in disclosures, which were
three grants. As a result, the gentleman's disclosure is not
complete.
So I would admonish the--Dr. Gruber, your choice really is
answer questions fully here and then supplement, or we will
seek to bring you back with the full disclosure in order to get
all the other numbers. It's really your choice. Your counsel
can advise you, but we find your--by your own testimony, we
find your submission deficient.
And your counsel is ill advised to say that it is
sufficient because it only includes grants and you have
contracts. You have admitted under oath that you have
contracts.
So those are not listed. And you are deficient. Again, I
want to--this is our last hearing if I don't have to recess and
come back again. I would like to not have to recess and come
back again. So, please, do not make this drag on longer. If you
can give answers to your best recollection and we will accept
an amendment, if that is the case, an addendum at a later date.
But the gentleman is entitled to have all questions, to the
best of your knowledge, answered. You took an oath saying you
would tell the truth, the whole truth, not the truth and only
what your counsel says is going to be discussed. It is all
questions, all answers.
And if Mr. Cummings were sitting in this chair or anyone
else, we could expect no less.
Mr. Cummings.
Mr. Cummings. Mr. Chairman, I think his counsel is talking
to him. Why don't we give him a second?
Mr. Lynch. Mr. Chairman, just on that question, I have a
PolitiFact document here, and they have a fact-checker thing
that has, you know, all kinds of numbers. They went into this
in depth as to what the gentleman was paid. And I was wondering
if we just enter this in as part of the record.
Chairman Issa. We will certainly be happy to enter in,
without objection.
Mr. Lynch. I thank you.
Chairman Issa. The gentleman from Ohio may continue. I ask
unanimous consent he have additional 30 seconds.
Without objection.
Mr. Jordan. I think I have a question on the table to Mr.
Gruber; I'm waiting for his answer.
Mr. Gruber. I was informed that I should report all Federal
moneys received through grants or contracts for this fiscal
year and the previous 2 fiscal year years. I did that. I was
received no Federal contracts----
Mr. Jordan. I don't care what you were informed, Mr.
Gruber, I care about what I'm asking you. And what I'm asking
you is, how much money did the taxpayers, State or Federal, pay
you to have you then lie to them? That's what I want to know.
Mr. Gruber. Over this fiscal year and the previous fiscal
year----
Mr. Jordan. No, no, no, no, no. Total. I mean, look, look,
this has been a 5-year ordeal with this law. We want know to
know how much you got from the taxpayer and then made fun of
them after you got money and lied to them.
Mr. Gruber. I don't recall the total.
Mr. Jordan. We want that information as quick as we can.
Let me switch gears.
Mr. Gruber, in a strange way, I kind of appreciate what you
said in the videos because it seems to me for the first time
someone came clean and told the truth. You told people you were
actually deceiving us. So here's my one question I want to get
to.
Politico reported that Steve Ratner called you ``the man''
when it came to Obamacare. The Washington Post said you were
the key architect of Obamacare. The New York Times said the
White House lent you to Capitol Hill to help Congress draft
Obamacare.
They say, Go on up there and help those poor folks on
Capitol Hill get it right. You're the expert. Go up and help
those Congressmen who don't know what they are doing.
President said he had, ``stolen ideas from you to draft
Obamacare.'' You visited the White House 21 times. You met with
the President--your own words--you met with the President in
the Oval Office.
So I have one question. A few weeks ago, when the video
surfaced, what was your reaction when the President of the
United States said you were just some adviser? Remember, you're
the man. You're the architect. Been to the White House 21
times. You go to Capitol Hill to help those poor saps get it
right. President stole from your ideas. You're the key guy. And
yet when the videos surface, the President of the United States
throws you under the bus and says you're just some random
adviser. What was your reaction to that, Mr. Gruber?
Mr. Gruber. My reaction was that my job was to be an
adviser. And that's what I was.
Mr. Jordan. Ms. Tavenner, you're currently enrolling people
in the Federal exchanges. How many people have you enrolled
thus far in this enrollment period?
Ms. Tavenner. I don't have that number before me. But I can
get you that number.
Mr. Jordan. You don't have that number. Well, even if you
did, we might believe it, based on past experience.
So let me ask you this. Are you familiar with the lawsuit
that--the court case King v. Burwell?
Ms. Tavenner. I am familiar with the case.
Mr. Jordan. Okay. If the ruling goes against and says what
Mr. Gruber said in some of those videos, that, in fact, those
States have not set up a State exchange can't give subsidies to
their enrollees, have you been explaining to people signing up
for Obamacare that, look, this all may change in a matter of
months? Have you been letting them know that they might have to
pay a lot more on their premiums, in fact have a tax liability
they don't know that they have today?
Ms. Tavenner. Congressman Jordan, nothing has changed for
consumers. They can still come in, they should come in----
Mr. Jordan. No. Are you telling people things may change?
We've got a court case, pretty big case. Fundamental question:
Are you telling them there might be a change?
Ms. Tavenner. This is not a closed case. Pretty much plain
language----
Mr. Jordan. I didn't say that. I say it might be. Are you
giving them a heads up that, in fact, things may change in a
big way in a few months?
Ms. Tavenner. I'm not going to speculate about the case.
Mr. Jordan. I'm not asking you to speculate. I'm asking,
are you telling enrollees that things may change in a few
months?
Ms. Tavenner. Nothing has changed for consumers, and I'm
telling them to come in and enroll----
Mr. Jordan. So they could get a shock and you're not
preparing them for the fourfold increase in premiums and the
tax liability they may have?
Ms. Tavenner. I have told you, employers--consumers should
come in, they should sign up, they should enroll----
Mr. Jordan. Mr. Chairman, if I could.
Ms. Tavenner, one last question.
Chairman Issa. Quickly.
Mr. Jordan. Do you think it's responsible to not tell the
millions of enrollees who are in States that have not set up a
State exchange, do you think it's at all responsible not to
tell them that things may change dramatically and they'd have a
tax liability and their premiums could increase as much as
fourfold?
Chairman Issa. The gentleman's time has expired. The
gentlelady may answer.
Ms. Tavenner. I'm sorry?
Chairman Issa. You may answer. Time has expired; you may
answer.
Ms. Tavenner. Thank you.
And I have told you this is not a closed case. And I am not
going to speculate. The law is pretty clear.
Chairman Issa. I will take that as a ``no,'' you are not
telling them, because of the statements you just made relative
to your opinion of the case. Is that right?
Ms. Tavenner. I have said nothing has changed for
consumers. They should sign up, come in and enroll.
Ms. Norton. Mr. Chairman, you know, if you're going to get
into the court case, no one can say that that would be
retroactive.
Chairman Issa. No, Eleanor. I'm not trying to get into it.
The gentleman was entitled to a ``no, we're not telling
people.'' And I wanted to make it clear that when she said why
she wasn't telling them that she wasn't telling them. And I
think she made that clear, as to why she decided not to inform
them.
Ms. Norton. I think that was a responsible thing to do. We
don't know--in fact, I doubt that it would be retroactive.
Chairman Issa. I thank the gentlelady.
The time belongs to the gentleman from Massachusetts, Mr.
Lynch.
Mr. Lynch. Thank you.
Chairman Issa. I'm sorry. Wait a second. I apologize.
The gentlelady from Washington, D.C., has already gone.
So--thank you. Mr. Lynch.
Mr. Lynch. Is it Mr. Clay or Mr. Lynch?
Chairman Issa. Mr. Clay was not noted. But if you'd like
him to go first, I certainly would take him.
Mr. Lynch. That's okay.
Chairman Issa. He's a delightful gentleman who has been
waiting to go first for a long time. He looks needy.
Mr. Lynch. He's going to wait.
Chairman Issa. Okay. The gentleman is recognized.
Mr. Lynch. I appreciate that. Thank you.
I want to thank the witnesses for attending.
In my former life, I actually negotiated healthcare plans
through collective bargaining. I was president of the
ironworkers union, Mr. Gruber. And we're having a lot of
problems in Massachusetts, in our home State, with some
provisions of the Affordable Care Act, especially the so-called
Cadillac tax.
Now, you and I know that for a very long time, health
care--until the Affordable Care Act, health care was not taxed.
So when I sat down with good employers, good employers who
cared about their employees, oftentimes they were more willing
to give their employees an increase in their health benefits
instead of putting it in their wages because wages were taxed
to the payroll tax and health care was not.
So, now, as a result of negotiating for 75 years on that
basis, you've got a lot of the unions across this country that
have built up multi-employer health benefit plans for health
care for their employees.
And because these employees have, instead of taking money
in their wages, they've taken money in their benefit plans,
we've got most of the healthcare plans these multi-employer
union healthcare plans are subject to this Cadillac tax today,
even though it doesn't come into effect until 2018.
So now what I'm seeing is that employers are running away
from their healthcare obligations because now they're going to
be taxed a 40-percent tax on everything over and above the
limits that have been established under the ACA.
So I've got formerly good employers who now are saying,
wait a minute, I'm going to get killed by this Cadillac tax.
Number one, they are abandoning their responsibilities to these
plans; they are trying to get out. They are trying to buy their
way out. They are just reorganizing. They are--in some cases,
they are cutting their companies in half so they can try to get
below 50 employees so that they are not covered. And new
companies are not coming into these multi-employer plans.
So now I've got the unions, a lot of them who were in favor
of this bill, now asking me to repeal it. Vote to repeal it.
They are coming to me. And I am a union member. I am a former
union president. And I've got these unions saying, repeal this
thing.
Fortunately for me, I voted against it, to begin with. I
voted against the Affordable Care Act because, unlike some
people, I actually sat down and read it. And it was--it was one
of the most complex bills that I have ever read, and I had a
full staff helping me with questions on that.
So I think that this has presented a lot of problems for
people who thought they were going to benefit from this plan.
And how do I--how do I fix this?
How do I fix this so that previously good employers who are
trying to do the right thing by their employees will continue
to do that?
Because these construction workers, they don't work 52
weeks a year. They get laid off in between jobs. They have bad
weather, they get--they have broken time. So they needed this
format to provide for their families to get health insurance.
And now these good employers are running away from their
healthcare obligations because they see this tax coming down
the road in 2018, and a lot of them are refusing to re-up on
their collective bargaining agreements. They are walking away.
And how do we help these employees? Because now they are
being told, go to the exchange. We don't do that anymore. We're
out of the healthcare business.
How do we help those folks?
Mr. Gruber. Well, Congressman Lynch, I'm not an expert on
collective bargaining agreements. And I can't----
Mr. Lynch. I guess.
Mr. Gruber. --comment further on that.
What I can say is that the way the Cadillac tax was
designed, there's no reason that these employers can't provide
affordable and comprehensive insurance under the provisions of
the Cadillac tax.
Mr. Lynch. It's 40--for every dollar over the limit, they
are paying $1.40.
Mr. Gruber. Once again, given where the limit's set,
there's no reason they can't provide affordable and
comprehensive insurance to their employees under the Cadillac
tax.
Mr. Lynch. But wait a minute. They are competing with other
employers on a bid. Just so you know how this works, if we are
bidding on a construction project, and you have 49 employees
and I have 150, my bid includes $13 an hour for health care.
Your bill--your bid is zero. How do I win the bid if I am
putting, for every man hour on that job, I'm putting $13 an
hour on my bid and you are putting zero on yours, how do I win?
I'm out of business.
Mr. Gruber. There's been a longstanding problem----
Mr. Lynch. You say I can afford it? How do I win that bid?
If my bid, for every man-hour on that job, I have to put $13 an
hour on my bid, and you can put zero and send your people to
the exchange or you're not--you're not obligated to account for
healthcare.
Mr. Walberg. [Presiding.] The gentleman's time has expired.
Mr. Gruber can answer.
Mr. Gruber. There's been a longstanding problem of
competition between employers that do and don't offer health
insurance. The Affordable Care Act actually tries to address
that through a free rider assessment on large employers that
don't provide insurance and tries to level the playing field in
that way.
Mr. Lynch. Well, it doesn't do it. Thank you.
Mr. Walberg. Thank the gentleman.
Now I recognize gentleman from Utah, Mr. Chaffetz.
Mr. Chaffetz. Thank the chairman.
Mr. Gruber, you also did some work for the Congressional
Budget Office. Correct? The CBO?
Mr. Gruber. I was on a CBO advisory council.
Mr. Chaffetz. When did that start?
Mr. Gruber. I don't exactly remember. It was probably----
Mr. Chaffetz. 2007. Correct?
Mr. Gruber. Mid 2000s, yes.
Mr. Chaffetz. And when did you stop working for the CBO?
Mr. Gruber. I did not--I was on the advisory council until,
I think, through 2008. I'm not entirely sure.
Mr. Chaffetz. You mean 2011? Is that correct?
Mr. Gruber. No. I did not go to meetings of the CBO
advisory council----
Mr. Chaffetz. Were you on the advisory council until 2011?
Mr. Gruber. I honestly don't know when they took me off it,
but I did not attend any meetings of that advisory council----
Mr. Chaffetz. Were you on the CBO panel in 2010?
Mr. Gruber. I did not attend any meetings of the CBO panel
in 2010.
Mr. Chaffetz. But you were part of that organization.
Did you have any communications with the CBO?
Mr. Gruber. Yes.
Mr. Chaffetz. So you didn't attend any meetings, but you
did have communication.
How many times did you attend the--how many times since
President Obama took office did you go to the White House?
Mr. Gruber. I don't recall exactly.
Mr. Chaffetz. Was it more than 20?
Mr. Gruber. No. It was not.
Mr. Chaffetz. I believe it was more than 20.
How many times do you think it was?
Going to the White House is a significant event. You
probably remember it.
Mr. Gruber. I made a number of visits to the White House,
primarily to the Executive Office Building to meet with members
of President Obama's staff.
Mr. Chaffetz. Did you ever meet with the President?
Mr. Gruber. I met with President Obama once during
discussion of the Affordable Care Act.
Mr. Chaffetz. How long was that meeting?
Mr. Gruber. Is was a meeting that lasted maybe an hour and
a half with about 20 people. I spoke for about 5 minutes.
Mr. Chaffetz. Was Mr. Elmendorf there?
Mr. Gruber. Yes, he was.
Mr. Chaffetz. What was your capacity in that meeting?
Mr. Gruber. It was a meeting of about six economic experts
to talk to the President and his staff about options for
healthcare cost control.
Mr. Jordan. Were you there as a CBO member or were you
there as an administration member?
Mr. Gruber. I was there as neither; I was there as an
economic expert.
Mr. Jordan. Well, somebody invited you there. You weren't--
somebody was paying you. Correct?
Mr. Gruber. No one paid me to be at that meeting. I was
invited to be at that meeting by the White House.
Mr. Jordan. We'll explore that a little bit more.
Mr. Gruber, will you provide copies of all the work product
you provided to the Federal Government related to the
Affordable Care Act, healthcare.gov, or any other healthcare
reform proposals?
Mr. Gruber. I--if that's a request of the committee, they
can take that up with my counsel.
Mr. Chaffetz. No, no, we're asking you, not your counsel.
Counsel works for you. So we're asking you, under oath, will
you provide this information to this committee?
Mr. Gruber. Once again, if the committee can take it up
with my counsel----
Mr. Chaffetz. No, no, no, no, no, Mr. Gruber. We're asking
you. You've been paid by the American taxpayers. Will you or
will you not provide that information to this committee?
Mr. Gruber. Once again, the committee can take it up with
my counsel.
Mr. Chaffetz. Mr. Chairman, this is something we have got
to get to the bottom of. I think Members on both sides of this
aisle should demand that those documents, paid for by the
American taxpayers, be part of the public record.
What are you hiding? Why won't you give those to us? Why
are we not entitled to those?
Mr. Gruber. I'm not an expert on the rules of what's
disclosable and what's not. But my counsel is, and he'd be
happy to talk to the committee about it.
Mr. Chaffetz. Why will you not give us those documents?
Mr. Gruber. I have not concluded one way or another on the
documents----
Mr. Chaffetz. Who owns those documents? Who paid for them?
Mr. Gruber. I'm not sure.
Mr. Chaffetz. You don't know who paid for those documents?
Were you paid by the American taxpayer?
Mr. Gruber. I had a contract, a technical contract with HHS
to do micro-simulation modeling.
Mr. Chaffetz. Was there any work product of that? Did you
actually come up with documents, have discussions?
Mr. Gruber. Yes. I had a large number of discussions.
Mr. Chaffetz. Will you provide copies of all the work
product you provided to the State governments related to the
Affordable Care Act State-based exchanges or any other
healthcare reform proposals?
Mr. Gruber. Once again, the committee can take that up with
my counsel.
Mr. Chaffetz. Will you provide copies of your
communication, including emails, memoranda, presentations, or
any other discussions or conversations you had with Federal or
State officials or employees related to the Affordable Care Act
exchanges or other healthcare reform proposals?
Mr. Gruber. Once again, that committee can take that with
up counsel----
Mr. Chaffetz. I need a ``yes'' or ``no.'' I'm not
interesting in talking to your counsel, I'm interested in
talking to you right now, under oath, having been paid by the
American taxpayer.
Will you or will you not provide that information?
Mr. Gruber. You can take that up with my counsel.
Mr. Chaffetz. Why do you believe you're entitled to not
give it to us?
Mr. Gruber. I don't know the rules of how you produce
documents, things like that. I'm not a lawyer, I'm just----
Mr. Chaffetz. Do you have documents?
Mr. Gruber. Do I own documents?
Mr. Chaffetz. Do you have documents?
Mr. Gruber. Yeah, I have documents.
Mr. Chaffetz. And you're not willing to give them to us.
Mr. Gruber. I have all sorts of documents. I have a piece
of paper in front of me. I don't understand----
Mr. Chaffetz. Documents that relate to the questions that I
just asked you, Mr. Gruber.
Mr. Gruber. I have----
Mr. Chaffetz. Do you not understand the question?
Mr. Gruber. I have--I performed grant work for the Federal
Government. There was work product from that work. I do not
understand the rules under which that work product is supposed
to be provided or not because I'm not a lawyer, and you can
take that up with my counsel.
Mr. Chaffetz. This is terribly frustrating, Mr. Chairman.
We will, I hope, get some cooperation on both sides of the
aisle.
Yield back.
Mr. Walberg. I thank the gentleman.
And, Mr. Gruber, it does appear that you have progressed in
your ability to be political. You answer questions better than
any politician sitting at this dais today. And it is
frustrating, and I would contend that your attorney is not
giving you adequate representation at this time.
This committee has the right to have information that has
been requested. And you have progressed from not talking simply
off the cuff and making stupid statements to now being entirely
political, to the point that you are hindering us in carrying
out our responsibility.
Mr. Meadows. Mr. Chairman?
Mr. Walberg. I now recognize the gentleman from----
Mr. Meadows. Mr. Chairman?
I would ask the chairman if this committee should consider
a subpoena to compel the witness to provide this kind of
information if he's not going to do it on a voluntary basis.
Mr. Walberg. I would recommend the gentleman take that up
with the committee chair whose portrait hangs behind us.
I certainly would concur with you. But I'm not going to
step in the place of the full committee chair at this point.
I thank the gentleman.
I now recognize the gentleman from Virginia, Mr. Connolly.
Mr. Connolly. Thank you, Mr. Chairman.
Dr. Gruber, maybe this is a good object lesson for all
academics in the consequences of sort of mouthing off and
showing one's superior knowledge, especially with respect to
this committee.
I have long felt, watching this committee in operation the
last 4 years, that we ought to post over the mantle on the
entrance in here, you know, ``Enter into this portal as a
witness at your own peril.''
All of a sudden, now we're talking about subpoenas and
lawyers and documents, and how often did you go to the White
House? It has a familiar refrain in terms of how,
unfortunately, witnesses have been handled, unless of course
they are friendly witnesses who don't like the Affordable Care
Act or believe the IRS has planted, you know, electrodes in
their brain.
And so you are getting the special treatment. And you
opened the door, unfortunately, because of remarks, which you
have apologized for in your testimony. Is that not correct?
Mr. Gruber. I apologize for the really inexcusable remarks
that I made in those videos.
Mr. Connolly. Thank you.
The incoming chairman of this committee asked you how often
you've been to the White House.
How often do you go to the Romney administration offices of
any kind when you were advising the Romney administration on
the--on what became really the model for Obamacare?
Mr. Gruber. I don't recall exactly. Dozens of times.
Mr. Connolly. Dozens of times. Did you ever meet with
Governor Romney?
Mr. Gruber. I had one meeting with Governor Romney.
Mr. Connolly. Just like you had one with Obama.
Mr. Gruber. Yes.
Mr. Connolly. So did that make you an intimate of the
Romney administration and the architect of Romneycare in
Massachusetts?
Mr. Gruber. I was an economic adviser to Governor Romney,
just as I was to President Obama.
Mr. Connolly. Thank you. And do you have documents from
those years that we might want to subpoena----
Let me withdraw the last part.
Do you have documents from the Romney period?
Mr. Gruber. Probably.
Mr. Connolly. Well, I would hope, Mr. Chairman, that if
we're going to have a broad subpoena, suggested by my friend
from North Carolina, that it be indeed brought and that we
encompass all of the Romney documents Dr. Gruber was involved
in. Because I certainly want to see whether this is a pattern.
Shouldn't be limited just to President Obama. Because, after
all, there is an antecedent; not just an antecedent, Romneycare
was the model for Obamacare.
Is that not true, Dr. Gruber?
Mr. Gruber. I believe it's true.
Mr. Connolly. I mean, for example, the tax consequences, is
it not true that right now in Massachusetts, you know, you can
be fined if you don't comply with Romneycare, and it's all run
through the tax administration in the Commonwealth of
Massachusetts?
Mr. Gruber. It is true that if you don't have health
insurance and don't meet certain exemptions in Massachusetts,
you have to pay a tax penalty.
Mr. Connolly. Right. And, by the way, what happened to the
uninsured percentage in Massachusetts? Did it go up? Did a lot
of people lose their healthcare, as predicted by the critics?
Mr. Gruber. The rate of insured fell by about two-thirds to
3 percent.
Mr. Connolly. Three percent. How many other States have a
3-percent uninsured rate?
Mr. Gruber. Massachusetts is by far the lowest in the
Nation.
Mr. Connolly. Lowest in the Nation.
Now, there were also predictions that the fines were so
relatively modest that employers would be tripping over each
other to divest themselves of employee-provided insurance plans
and just go on to the State exchange. Did that happen in
Massachusetts?
Mr. Gruber. No, it did not. Employer-sponsored insurance
actually rose by 10 percent in Massachusetts after we passed
Romneycare.
Mr. Connolly. Can you explain the interpretation of your
statement--and I'm going to read your statement: In the law, it
says that the States don't provide them, the Federal back stop
will. The Federal Government has been sort of slow in putting
out its backstop, I think partly because they want to sort of
squeeze the States to do it. I think what's important to
remember politically is if you are a State and you don't set up
an exchange, that means your citizens don't get their tax
credits.
Opponents of the Affordable Care Act are using these
remarks to further the argument that the law does not authorize
tax credits for States that did not step up their own
exchanges.
Is that a correct interpretation of the law and of your
statement?
Mr. Gruber. I don't believe it's a correct interpretation
of either the law or of my statement. As I said my opening
remarks, my statement, while poorly worded and much too glib,
but I believe the point I was making was that at the time I
gave that statement, which was 2012, it was not clear how
effective the Federal exchange would be. It was not even clear
who would be in the White House to implement said Federal
exchange.
As a result, States might be concerned the Federal exchange
would not be implemented, and they would have to set up their
own exchange.
Mr. Connolly. Do you agree, Dr. Gruber, that, as written,
the law makes tax credits available in every State, regardless
of whether the State or the Federal Government runs the
exchange?
Mr. Gruber. In every--in every opportunity I've had to
model or interpret the law, I've always made that assumption.
Mr. Connolly. Yes.
Mr. Chairman, my time is up. I'd like unanimous consent to
enter into the record a letter from Doug Elmendorf, the head of
CBO, to Chairman Issa, dated December 6; and an article by Tom
Harkin, Ron Wyden, Sandy Levin, George Miller, and Henry
Waxman, on the Affordable Care Act and what opponents are
cherry-picking in terms of facts.
Mr. Walberg. Without objection.
Mr. Connolly. I thank the chair.
Mr. Walberg. I thank the gentleman.
Recognize myself for 5 minutes of questioning.
It is--at least to me, it's apparent today in what we have
heard, what's gone on here, that Americans now know that
government transparency under this administration simply means
what you see is not what you get. And that's concerning to me.
Ms. Tavenner, do you believe Obamacare was crafted in a way
that was transparent to the American taxpayer?
Ms. Tavenner. I certainly believe that the work that I've
been part of for the last 5 years has been transparent.
Mr. Walberg. Was Obamacare crafted in a way to be
transparent?
Ms. Tavenner. I was not here during the crafting of
Obamacare.
Mr. Walberg. Ms. Tavenner, would you say the administration
was transparent in its implementation of Obamacare, then?
You've been here for that.
Ms. Tavenner. Sir, I think we have tried to be transparent.
We have tried to provide documents, including the documents
that we sent yesterday. To date, we have already provided
135,000 pages of documents and provided more than a dozen
transcribed interviews. So I think we have tried to be
transparent.
Mr. Walberg. But not completely.
Ms. Tavenner. Wherever we can, we have tried to be----
Mr. Walberg. Wherever we can. Okay.
Another term that could be used in this hearing, ``whenever
we can,'' ``I don't recall,'' ``probably.'' Those are
reoccurring terms.
Mr. Gruber, the Obama administration promised the American
people 37 times that if you like your plan, you can keep your
plan.
When you were working on the law, did you believe, Mr.
Gruber, did you believe that no one would lose a plan they
liked due to Obamacare?
Mr. Gruber. I believed that the law would not affect the
vast majority of Americans.
Mr. Walberg. The vast majority. But did you believe that no
one, as the President said, would lose a plan they liked?
Mr. Gruber. As I said, I believed it would not affect the
vast majority of Americans. But it is true that some people
might have to upgrade their plans because their plans were not
comprehensive as defined under the law.
Mr. Walberg. So they couldn't keep their plan even if they
liked it.
Mr. Gruber. What the law says is there's minimum standards
to be met.
Mr. Walberg. Why did the President make this representation
if his experts, including you, knew it was not true that some,
as you've said, would not be able to keep their plan, they
would have to upgrade or they'd have to change it?
Mr. Gruber. I'm not a political adviser, and I have no
answer to that question.
Mr. Walberg. You acknowledged in a 2013 article in the New
Yorker that not everyone who liked their plans could keep their
plans, Mr. Gruber. When you knew that the administration's
representations to the American people were false, such as in
this instance, did you ever voice any concern? Why or why not?
Mr. Gruber. I interpreted the administration's comments as
saying that for the vast majority of Americans, this law would
not affect the productive health insurance relationships they
have. And so I did not see a problem with the administration's
statement.
Mr. Walberg. But you're an economist with a model that
you've described as entirely accurate. You're a learned
professor. And we don't take that away from you at all. And yet
the President 37 times said, If you like your plan you can keep
your plan.
I'm here today to say that in my constituency of almost
800,000 people, Julie Boonstra, leukemia patient who had a plan
she liked couldn't keep that plan. And she's not stupid. She
couldn't keep that plan.
Mark and Kate, a young pastor and wife at a local church,
now expecting, as of yesterday cannot keep the plan they had
and can't find a plan that's adequate for them to replace it.
Dustin, a hardworking young man in my district, spent
almost the entire weekend trying to opt on to Obamacare from a
plan that he lost, he couldn't keep. And, as of yesterday
morning, I watched him try to get a plan through to the Web
site, through talking with people connected with the Web site.
He still couldn't get it. He had a plan he liked. He's not
stupid. He couldn't keep it.
Numerous constituents have contacted me saying that while
they may have found a plan under Obamacare, not necessarily a
plan that they liked or they could keep, but found a plan, like
Mr. Goldmann, that was reasonable in cost, yet when they got to
the point of having to pay their deductibles, their copays,
their out-of-pocket expenses or the prescription drug costs,
they couldn't afford it.
And I would suggest that again transparency here is not
what you see is what you get.
My time has expired.
I now recognize Mr. Cartwright for his 5 minutes.
Mr. Cartwright. Thank you, Mr. Chairman.
And I thank the witnesses for appearing today in yet
another instance of the gnashing of teeth over the Affordable
Care Act.
Administrator Tavenner, you were not there at CMS for the
crafting of Obamacare. I was not in the Congress, and many of
my colleagues here on the dais were not in the Congress for the
voting on the ACA.
But I believe what the American public wants of us is to
make the best of things, to take this law, to improve it, to
make it work for everybody in the United States, and that's why
it pains me to have to sit through these hearings while we
criticize those who may have said something that understated or
overstated the facts.
To be sure, there are people who are traveling through this
world and through their lives unburdened by excessive concern
for the truth.
And maybe, Mr. Gruber, at times in your life, you've been
one of them. But there is--you know, there is--there's a chance
for repentance and renewal in life, and I hope you will take
that chance, Mr. Gruber.
But, Ms. Tavenner, I want to pick up on something that Mr.
Lynch was talking about. And he really didn't give you much
time to respond because we only get 5 minutes and it took him
the balance of his 5 minutes to explain a concern, and that was
about the Cadillac tax. And I'm hearing about that at home as
well. And I simply--this is a yes or no question, Ms. Tavenner.
Will you undertake to review the Cadillac tax and perhaps
rethink it and engage those with whom you work to rethink it
and maybe even go back to the drawing board about the Cadillac
tax in an effort, as I said, to take this law and improve it
and make it work for all Americans?
Ms. Tavenner. I think the President has been clear and that
he would be willing to work with Congress to make improvements
to the law.
Mr. Cartwright. Well, I thank you for that.
I also want to talk about costs a little bit. In an
unguarded moment, the chairman of this committee listed a
number of statements that he considered to be untrue or
falsehoods. Some of them I agree with.
But among them he listed the idea that healthcare spending
in this Nation has had the lowest increase in 50 years. I was
surprised to hear him list that among statements he considered
to be falsehoods.
Would you comment on that, Ms. Tavenner.
Ms. Tavenner. I would say that, based on the healthcare
expenditure report last week that our Office of Actuary did,
that that statement was not true. It is the lowest trend in
healthcare spending that we've seen. It continues a trend that
we've seen for the last several years.
This year was one of the lowest for 2013 and the lowest
that the healthcare expenditure report has on record since
1960. So I think healthcare expenditure is at an all-time low.
There's still an increase year over year, but expenditure and
the slope of that growth has greatly slowed.
Mr. Cartwright. Now, there's not a whole lot refreshing to
talk about when we talk about the ACA and recriminations over
it, but that--that's one of them, isn't it?
Ms. Tavenner. That's one of them. I think 6.7 million
Americans signed up in the marketplace is another. Over 9
million new to Medicaid and CHIP. These are all good things.
Mr. Cartwright. Now, in conjunction with that, you know,
I've been an employer through the 1990s and the 2000 decade. We
saw--and we provided health care for our employees.
And we saw increases that were in the double digits, 10,
15, even 20, percent, even higher in some years, for the
premiums we were paying to cover our employees. It was awful. I
was dismayed by those numbers, and it was something that hurt
every year to do.
What's the--what's the average increase we're looking at
this year in premiums under the ACA, Ms. Tavenner?
Ms. Tavenner. Under the ACA, while it certainly can vary by
region, we are looking at single-digit--in the low single
digits for increases.
In the employer-sponsored insurance, separate and apart
from the marketplace, 3 percent this year, which is--again,
follows an overall extremely low trend.
Certainly there have been changes in co-pays and
deductibles along with that, but it still is a much lower
growth than we've seen in years past.
Mr. Cartwright. Again----
Ms. Tavenner. And I share your concern for the last few
years.
Mr. Cartwright. --more refreshing news from you.
Thank you for appearing today, Ms. Tavenner, and all the
witnesses.
I yield back, Mr. Chairman.
Chairman Issa. [Presiding.] Thank you. The gentleman yields
back.
I now ask unanimous consent that our colleague from South
Carolina, Mr. Rice, be allowed to participate in today's
hearing.
Without objection, so ordered.
We now go to the gentleman from North Carolina, Mr.
McHenry.
Mr. McHenry. Well, Dr. Gruber, you know, as everyone knows
and as the American people know, when the President said, ``If
you like your plan, you can keep it,'' turns out it was the lie
of the year. Right?
I mean, this is a very significant thing. And my
constituents in North Carolina and--actually, North
Carolinians--according to the North Carolina Department of
Insurance, 473,000 North Carolinians lost their health
insurance because of Obamacare.
So this is perplexing. Right? You had a moment of clarity
and honesty where you said, you know, it was a lack of
transparency that helped pass Obamacare. And I concur, and I
appreciate your honesty.
I think it's horrific, though, that you participated in
some level on obscuring the truth from the American people in
order to pass this bill. Now, you apologized for that, and I
thank you for that.
And the American people hear you loud and clear. And as a--
sort of as a matter of morality, for you to apologize is
really--I know it's a tough thing to do publicly, but I thank
you for doing that.
So, you know, when I think about my constituents, though,
did you think that there will be such a large number of folks
that would lose their health insurance?
Mr. Gruber. I don't know the exact number in North
Carolina, but I----
Mr. McHenry. Well, it's 473,000, according to the
Department of Insurance and the Raleigh News & Observer.
Mr. Gruber. What I was focused on was the net increase in
newly insured we've had under--have under the law, which has
been quite substantial.
Mr. McHenry. Okay. So it's not relevant to your calculation
that there will be people that would lose their health
insurance?
Mr. Gruber. That was part of the calculation.
Mr. McHenry. It was?
So there--there is churn, would you say?
Mr. Gruber. There's always been churn in this market.
Mr. McHenry. Sure.
Did you think it would be such a large number that would
lose their plans, though?
Mr. Gruber. I don't recall the exact numbers I modeled, but
we did model some individuals would lose their existing plans
and move to new forms of coverage.
Mr. McHenry. Well, you--I think you anticipated it. And
you're obviously very well prepared. I think you anticipated
this question.
Is it similar or dissimilar to the number that you
calculated?
Mr. Gruber. I don't know of a national estimate of how many
people have lost health insurance. So I don't know how it
compares to what I projected.
Mr. McHenry. So was there a discussion at senior levels in
the White House and HHS about this potential loss of people's
health insurance plans?
Mr. Gruber. I don't recall whether they were when I was--
when I was there. I can't speak what happened when I wasn't.
Mr. McHenry. So was there--but there was no moment of moral
clarity, of honesty, that you came to publicly that we now know
about and most Americans know about? There was no discussion at
the time that maybe we should put the brakes on this, that
we're going to have a lot of people lose their health insurance
plan--their preferred health insurance plan?
Mr. Gruber. There were--I was present for discussion--as I
said, I provided numbers and I was present for discussion of
those numbers and interpretation of what they meant in terms of
how the law would affect individuals.
Mr. McHenry. Did anyone say, ``Well, pause for a moment.
The President's been out saying, 'If you like your health
insurance plan, you can keep it.' Gosh, maybe we should tell
him that that's not, in fact, the case. Maybe he should change
his wording a little bit''?
Mr. Gruber. I was not in any discussion of presidential
communication or messaging.
Mr. McHenry. Okay. But in the meetings where you went
through these numbers and you said to the administration--and,
look, you've got plenty of experience on this--you said to this
administration--because you're in the employ of this
administration--you said there will be people that lose their
plans. Right?
Now, you said there are also going to be people that get
other plans. Right? But you said there will be people that will
lose their plans. Did they--did you--was this not registered?
Did--did this fall on deaf ears?
Mr. Gruber. All I know is what my modeling showed and what
I conveyed.
Mr. McHenry. And you conveyed that there would be, in fact,
people that lose their preferred health insurance plan?
Mr. Gruber. I conveyed that there would be churn in the
market and some people would move to different insurance plans,
yes.
Mr. McHenry. So, as I said before, my interpretation of
``churn'' is that some lose and some gain.
So when you have the President going out saying clearly,
``If you like your plan, you can keep it,'' it was, in fact, a
lie, based off your numbers, based on the data you provided
this administration. Is that correct?
Mr. Gruber. I interpreted the President's statement as
referring to the fact that the vast majority of Americans would
be able to maintain their health insurance arrangements under
the Affordable Care Act.
Mr. McHenry. Okay. So you also said that, you know, the
only way to pass this type of health insurance is to actually
pay lip service to fundamental cost control, right, that you
actually need to talk about cost control in order to pass this
type of health insurance change? So was it, in fact, just lip
service?
Mr. Gruber. Fundamental cost control is very, very hard in
health care. The Affordable Care Act does not solve the problem
of high and rising healthcare costs----
Mr. McHenry. But it did----
Mr. Gruber. --in America.
Mr. McHenry. It did pay lip service, though?
Mr. Gruber. No. It did more than lip service. The
Affordable Care Act is, by far, the most ambitious piece of
legislation in our Nation's history in terms of moving forward
on cost control.
Mr. McHenry. Okay. Okay. And so has it outperformed your
model or underperformed your model?
Mr. Gruber. My model, as with the Congressional Budget
Office model, over the budget period did not----
Mr. McHenry. No. I'm saying so far.
Mr. Gruber. So far, the law, in terms of health insurance
coverage and other things, is matched fairly well with what the
model predicted.
Mr. McHenry. Okay. So that lip service was important, in
fact, to pass it?
Mr. Gruber. I don't understand the question.
Mr. McHenry. Okay. Well, you said, in order to pass it, you
have to pay lip service to fundamental cost control.
Mr. Gruber. The--as I've said, fundamental cost control is
very difficult----
Mr. McHenry. It is.
Mr. Gruber. --but the Affordable Care Act takes all the
first steps that are necessary to try to move us down that
path.
Mr. McHenry. Okay. My time has expired. Thank you.
Chairman Issa. I thank the gentleman.
I ask unanimous consent to have the actual numbers as
they've been revised placed in the record relative to the
Affordable Care Act. Without objection, so ordered.
Chairman Issa. The gentleman from Vermont, we are pleased
to have you join us.
Mr. Welch. Thank you.
Chairman Issa. And you're recognized for 5 minutes.
Mr. Welch. Thank you very much, Mr. Chairman.
A couple of things.
Number one, Mr. Gruber, you've apologized for the
intemperate, you said, insulting remarks. It's unfortunate.
This whole debate about health care is so fundamentally
important to this country. It's been divisive in Congress.
We had a partisan vote and strongly different points of
view about it. And, unfortunately, the remarks you made
provided clear ammunition for opponents to use that to indict
the entire bill.
But when you start commenting about what you expect might
be a legal outcome, do you have any training as a lawyer?
Mr. Gruber. No, I do not.
Mr. Welch. When you comment on the quality of mind of the
American people, which I think all of us here have a great deal
of respect for the people we represent, you would, I take it,
apologize for any insulting remarks you made.
Mr. Gruber. It was inexcusable that I tried to appear
smarter by insulting others.
Mr. Welch. All right. And the other thing.
I listen to my colleagues here, and they talk about folks
who had a bad experience with the healthcare bill. And some
people in--some people have had good experience. Some people
have had bad experience. But it really is profoundly important
to the American people that they have security about health
care.
And is it your view--I'm now going back to your area of
expertise--that, broadly speaking, the American healthcare
system has been improved as a result of the passage of the
Affordable Care Act?
Mr. Gruber. Yes.
Mr. Welch. Just be specific as to a number of items that
are better now than before the Affordable Care Act was passed.
Mr. Gruber. The Affordable Care Act has lowered the rate of
uninsurance. About 10 million people have gained health
insurance, according to the latest estimates.
The Affordable Care Act has ended the fact that individuals
face pre-existing conditions and the inability and the
financial insecurity that comes from having to buy insurance on
their own.
And the Affordable Care Act has contributed to historically
slow rate of healthcare cost growth.
Mr. Welch. And is it also your opinion that the Affordable
Care Act shares many things in common with what was called
Romneycare in Massachusetts?
Mr. Gruber. Yes, it is.
Mr. Welch. And you worked on the--you worked on the
Massachusetts version with the Romney Administration. Is that
correct?
Mr. Gruber. Yes, it is.
Mr. Welch. And I think I heard you say that the uninsured
rate in Massachusetts is about 3 to 4 percent.
Mr. Gruber. It's fallen to--before the Affordable Care Act,
it fell to about 3 percent. It may be lower today.
Mr. Welch. And my understanding in the passage of the
Massachusetts bill is that there actually was a bipartisan vote
that supported that legislation. Is that correct?
Mr. Gruber. Yes.
Mr. Welch. Which we did not--that eluded us here,
unfortunately, in this Congress.
Now, my view is that there's a lot of things we still have
to fix in our healthcare system. I've never had the view that
any single bill is going to be the magic fix, that it has to be
an ongoing process.
And I'd ask you--and the cost issue on health care is the
one that I think needs even more attention. But, first, I'd ask
you and Ms. Tavenner: What has happened to the growth of
healthcare spending since the passage of the Affordable Care
Act?
Ms. Tavenner?
Ms. Tavenner. I think, as we've discussed earlier, it's at
historic lows. It's 3.7 percent, I believe, for 2013, which is
the lowest on record since 1960.
Mr. Welch. And does that apply across the board, whether a
person is in the healthcare--in the Obamacare or on their own
private or employer-sponsored healthcare?
Chairman Issa. Ms. Tavenner, would you please put the
microphone closer to you.
Ms. Tavenner. I'm sorry.
It is across the board.
Mr. Welch. All right. And, Mr. Gruber--or Dr. Gruber, what
would you cite as important elements in the Affordable Care Act
that has helped slow the rate of growth in overall healthcare
spending?
Mr. Gruber. The Affordable Care Act took a number of steps
in a wide variety of directions to try to slow spending, most
notably, I think, as Administrator Tavenner mentioned, change
in the way that healthcare providers are reimbursed, penalties
on readmissions for hospitals--we've seen an enormous
reduction, which has lowered costs--and really just led to some
very innovative thinking on how we can fix our broken fee-for-
service medical system.
Mr. Welch. And my observation is that, in Vermont, where
we've had an ongoing discussion about health care and still are
in the midst of that, we've got healthcare providers--our
hospitals and our doctors--that are really focused on trying to
figure out better ways to treat, to curb infections, to change
the billing process, but they're on the front lines.
And what are some of the things that we can do to help them
be successful in providing better health care at lower cost?
Mr. Gruber. I think the most important thing is to continue
to learn from the ongoing experiments that are going on in our
Nation's healthcare system to try to understand what's working
to deliver this low rate of healthcare cost spending.
Mr. Welch. Ms. Tavenner?
Ms. Tavenner. I would agree with that.
I would also say--and we have tried to do this through the
Innovation Center--some upfront help in how to work with
electronic health records and how to build an infrastructure
that goes from fee-for-service to actually assuming risk and
looking at it on a----
Mr. Welch. And accountable care organizations are a part of
that?
Ms. Tavenner. Yes.
Mr. Welch. All right. Thank you.
I see my time is up. Thank you. I yield.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from Oklahoma, Mr. Lankford.
Mr. Lankford. Good morning, y'all.
So I want to go through several transparency issues.
Ms. Tavenner, what was the plan for States that are not
self-sufficient in their oversight and their running of their
exchanges by January the 1st? The law states, by January 1,
2015, they have to be self-sufficient.
Ms. Tavenner. I think currently--I assume you're talking
about the smaller States than----
Mr. Lankford. Yes.
Ms. Tavenner. Currently, they are sufficient--self-
sufficient and are obviously carrying through for 2015. We are
in ongoing discussions with them.
Mr. Lankford. How are you defining ``self-sufficient''?
Ms. Tavenner. So, as you are aware, the funding ends--the
1311 funding will end at the end of this year. Most of them are
dependent on their user fee and some other sources of revenue,
and that will carry them through 2015. But we will be having
ongoing discussions with some of the smaller States.
Mr. Lankford. The State of Vermont has had some
conversations about the cost overruns that they're experiencing
this year on the exchange, and they're pursuing Federal grants
to help make that gap for this year.
Rhode Island had--even this week there was an editorial
that came out in the Providence Journal suggesting to the
Governor to punt this and to go back to the Federal oversight
because of the cost overruns there.
So there is some buzz and some conversation about States
and what they're going to do in 2015.
My question is--the law requires that they be self-
sufficient by that point. And so my--a two-fold question on it.
One is, for the States that come back to you and say, ``We
need a grant. We need additional dollars. We need some
additional help in 2015,'' will they get Federal dollars,
contrary to the law saying they must be self-sufficient?
Ms. Tavenner. There will not be Federal dollars. Any
Federal dollars awarded have to be awarded by the end of 2014.
So there is not additional----
Mr. Lankford. Could they get a larger portion given to them
at the end of 2014 with the implication, ``This is to help your
shortfall this year and to help you for next year''?
Ms. Tavenner. It's very specific what the grants can be
used for. So I'll be glad to get you that information.
Mr. Lankford. Would it be used for 2015 spending?
Ms. Tavenner. So that is very specific. So I'll have to get
you that information. I can't answer that right now.
Mr. Lankford. Well, I'm just saying the law says they have
to be self-sufficient by January the 1st----
Ms. Tavenner. Right.
Mr. Lankford. --2015.
Ms. Tavenner. And there----
Mr. Lankford. If the grant is given to them and those
dollars can be used after January the 1st, 2015----
Ms. Tavenner. I'm happy to----
Mr. Lankford. --that's contrary to the law.
Ms. Tavenner. I'm happy to get you that information.
Mr. Lankford. I'm just--I'm just asking--I'm just asking--
I'm not trying to be contrary now.
Ms. Tavenner. Yeah.
Mr. Lankford. I'm just asking a question.
Is there any money being given to them that they will use
after January the 1st, 2015?
Ms. Tavenner. I'm not trying to be contrary either. I just
have to get you specific information about each State. So I
can't answer that in a general question. So I'll get you that
information.
Mr. Lankford. Okay. Well, just a blanket response on it
would be, ``We're definitely going to follow the law on it.
We're not going to--we're not going to give them extra funds
this year that they'll really use next year, contrary to the
statute.''
Ms. Tavenner. I am happy to get you specific information.
Mr. Lankford. Okay. Well, I--we'll look forward that that
and we'll definitely--we'll assume that we're going to follow
the law on that as it has been written out.
The question that goes along with that as well, again,
going back to the transparency part of this--we have the
numbers for this month, the 6.7 million that have the
enrollment.
Will we get monthly effectuated enrollments from here on
out? This is--we're a year into it. Will there be consistent
snapshots a month at a time?
Ms. Tavenner. So there--and I think this is what led to our
mistake. So if you will indulge me for a minute, let me try to
explain.
Effectuated enrollment are actually those individuals who
have paid.
Mr. Lankford. That's right.
Ms. Tavenner. Okay? So what we gave, the information, the
6.7, that was current. We will be able to run another
effectuated enrollment toward the end of the year, which will
cover 2014. So, yes, we can get you that information.
Mr. Lankford. Will we just get monthly snapshots from here
on out----
Ms. Tavenner. Well, there's really only 1 more month left.
Mr. Lankford. Right. But I meant just after that.
But the open enrollment period goes all the way through
into early next year as well.
Ms. Tavenner. So that's 2014. So let me close 2014. And
last night we sent Chairman Issa a large data dump.
Mr. Lankford. A lot, including questions that you and I had
talked about in September of last year that I got the answer
for at 6:30 last night.
Ms. Tavenner. Yeah.
Mr. Lankford. I appreciate that.
Ms. Tavenner. We try. We may be slow, but we try.
The second thing has to do with 2015. And so the first time
we would be able to actually look at effectuated enrollment in
2015 would probably be mid-February or late February.
Because, remember, payments are not made until sometime in
January. Those payments have to be trued up. We have to check
them for accuracy, not double-count dental again. So you will
probably be looking at that in the spring.
Mr. Lankford. So you're getting numbers on that
consistently as well. We would just like to be able to get
actual numbers on that.
So is that every month we'll get those after that? Will it
be every 2 months? When will we get snapshot totals?
Ms. Tavenner. So I----
Mr. Lankford. Because we've got to get into a rhythm. Just
plan selections--I went on the Web site, put it in the shopping
cart. It's not enough.
Ms. Tavenner. Right. And this is where I think we will do
regular intervals. We should be able to provide it to you
monthly.
Mr. Lankford. And what was the estimate that we hoped to
have by this point in the original rollout of the Affordable
Care Act for effectuated enrollments for this month?
Ms. Tavenner. You know, that's interesting. I don't know
that we ever had a publicly stated goal for enrollment for
2014.
Mr. Lankford. CBO did, obviously.
Ms. Tavenner. CBO had 7 million originally, and then they
revised that downward to 6 million sometime in the spring of
2014. But I don't think we ever had a public goal. We're
delighted with 6.7.
Mr. Lankford. The CBO number, I think, originally for the
end of this year was 13 million. Is that correct?
Ms. Tavenner. No. I don't think that's correct.
Mr. Lankford. Well----
Ms. Tavenner. I'd have to look at that.
Mr. Lankford. 10? 12? What's the guesstimate?
Ms. Tavenner. So--you mean for the end of 2015.
Mr. Lankford. 2014 or 2015.
Ms. Tavenner. Yes.
Mr. Lankford. What's the enrollment?
Ms. Tavenner. The end of 2014, I believe, was the 7 million
that was revised down to 6 million, if I remember correctly.
For the end of 2015, by this time next year, I think it was 13
million.
Mr. Lankford. Okay. Then--if the chairman will indulge me
one last question line.
Just another transparency number, and that is the Medicaid
numbers. I'm trying to get accurate numbers based on the
expansion that occurred.
The new expanded definition of Medicaid in States that took
that expansion, will we be able to get a listing of the
difference between people that enrolled in Medicaid, just
enrolling in Medicaid, and those who became eligible based on
the expansion?
Ms. Tavenner. Yes. We're actually working on that report
even as we speak.
Mr. Lankford. Okay. When do you think we would get that
number?
Ms. Tavenner. Soon.
Mr. Lankford. Can you define ``soon.'' I asked you
questions in September, and I got them last night at 6:30. So
help me define ``soon.''
Chairman Issa. I might note that Congress will be going
sine die soon.
Mr. Lankford. Yeah.
Ms. Tavenner. Right. I don't think we'll meet that
definition of ``soon.''
Chairman Issa. So the Senator will be getting a report next
year.
Ms. Tavenner. Yes.
Mr. Lankford. So help me understand ``soon'' just so I can
get a ballpark on----
Ms. Tavenner. So I--really, it's in the process. So----
Mr. Lankford. In geological terms of ``soon'' or in more of
a----
Ms. Tavenner. In geological terms of ``soon.''
I think it would be early 2015.
Mr. Lankford. How about a month?
Ms. Tavenner. How about a month. We'll try----
Mr. Lankford. That would be great.
Ms. Tavenner. --for a month.
Mr. Lankford. Thank you.
I yield back.
Chairman Issa. I thank the gentleman.
And early on in my chairmanship I probably should have
gotten into the difference between geological, Biblical,
calendar ``soons,'' and I could have--I could have done so much
to speed things up.
We now go to the gentlelady from New Mexico.
Ms. Lujan Grisham. Thank you, Mr. Chairman.
And I also want to thank you for tackling a very difficult
challenge often in this committee.
And while I--I have concerns about rollout from--that are--
I think have been extended, actually, or not addressed as
effectively as it could be from last year. I think we're all in
a better place, given that this is a much smoother rollout.
But I want to hit, if I can, three things.
One, the Affordable Care Act deals with cost not just by
making some transformations to a fee-for-service environment,
but just by having more people covered and lowering uninsured
and uncompensated care costs. You know, we have that shift,
which is great, but it didn't do enough, in my opinion, to deal
with quality or cost.
So we're going to have to continue to get people insured,
and we're going to have to continue to deal with real cost
issues and real structure issues in the way in which we
reimburse providers and incentivize patients.
Given that, our State, New Mexico, had one of the lowest--
or highest uninsured populations in the country pre-Affordable
Care Act. And we are doing better, but we could do much, much
better.
And, in fact, given our large Hispanic population, which
continues to be a real challenge across the country, can--Ms.
Tavenner, can you talk to me a little bit about what you're
doing better about outreach and transparency and communication,
education.
Because that--the Hispanic demographic, as I understand it,
was the lowest. We didn't penetrate that population in terms of
increasing coverage. So what are you doing to specifically
address that?
Ms. Tavenner. Right. I think, for starters, this is
something--you're correct. We identified at the end of the open
enrollment period last year that this was an area we had not
penetrated as deeply as we wanted.
So we created a work group, and we've gone about it several
ways. We've created advocacy groups. We've worked with
navigators and assisters to make sure that they are trained not
only----
Ms. Lujan Grisham. Be specific about that advocacy work.
Talk to me about specifically how that would translate to
somebody in New Mexico having a better chance for being
enrolled.
Ms. Tavenner. So let me start with the navigators and
assisters in New Mexico. We have done more to ensure that--as
we made the awards this year, that we were dealing with
bilingual staff in all areas because that's something--and not
just a presence, but a significant presence.
We have been working through--and I can--I can get you
information specific to your State, but we have been working
with advocacy groups inside the State to work--many times----
Ms. Lujan Grisham. I would really encourage you to do that.
And I appreciate that you're trying to answer. And I want to
make sure that, with my limited time, I get as much out as
possible. I have a suggestion for you.
Ms. Tavenner. Okay.
Ms. Lujan Grisham. I attended many of the enrollment
efforts last year, and you're touching an individual consumer
six times in New Mexico. You lost them after the--if you have
them in the room, get them enrolled. And that's a huge problem.
And you're minimizing, I think, the experience that our
consumer here today presented--I really appreciate your
presence here--that it can and does work. Now we need to make
sure that people have that opportunity.
The second thing is I really wanted--as you're getting more
people covered, I want us to start exploring--and I'm asking
for the administration to work more closely with members of
Congress.
Because while--we are seeing access and the exclusion of
pre-existing conditions--having that be a barrier to providing
coverage and premiums that are lower, lower in my State,
certainly, but out-of-pocket costs and deductibles are higher,
which means that you still don't get folks that are accessing
the healthcare system even if they have coverage.
And while I think most folks still are not understanding
that the Affordable Care Act really minimally does anything to
insurance companies when we set the floor about who they have
to cover, but they make decisions about their provider networks
and they make decisions about what they're going to pay docs
and they make decisions about what hospitals are going to be in
their network and they create that environment and--we're going
to have to do more to get them to lower total costs and to
create much more expansive provider networks. And I'm
encouraging you to be very assertive in that role and work with
members of Congress to get that done.
And with the limited seconds left, on the--the last part
is, like my colleague, Senator Lankford, since August and
September, we've been waiting for you to respond to New Mexico
about behavior health access. While that's not particularly
related just to this hearing in the ACA, it is a transparency
issue. And we are looking for numbers.
And my understanding is that now another provider has
dropped all behavior health coverage in the southern part of
the State. And I'm--I'm really encouraging you that, while you
wait for 3 months to respond, that's 3 months where New
Mexicans don't get healthcare coverage in Medicaid. And I'm
encouraging you to take a stronger, more productive role to
stop the damage in New Mexico.
Ms. Tavenner. Thank you. We'll do.
Chairman Issa. I thank the gentlelady.
We now go to the gentleman from Arizona, Dr. Gosar.
Mr. Gosar. Thank you, Mr. Chairman.
Dr. Gruber, in your testimony, you stated, ``I'm not a
political advisor nor a politician.'' I like that statement.
I'm a dentist by trade impersonating a politician. So I want to
commend you on that.
But there's something very similar about you and me, as
you're very astute to detail, like me. Right?
Mr. Gruber. I like to think I pay attention to detail. Yes.
Mr. Gosar. Yeah.
Because the beauty is in the detail. Right?
Mr. Gruber. Often that is the case.
Mr. Gosar. Yeah.
So did you lie about any of your comments when you publicly
were--some of the aspects that we saw on television? Were those
outright lies or were they just not politically pleasant?
Mr. Gruber. They were not lies.
Mr. Gosar. They were not lies.
So they were truthful in regards to a stalwart evaluation
of a process. Right?
Mr. Gruber. They were, once again, my inexcusably trying to
conjecture about a process about which----
Mr. Gosar. No. But I want to go back to this.
Mr. Gruber. --I have no expertise to----
Mr. Gosar. You weren't lying. You were very truthful about
the process.
Mr. Gruber. I was, once again, trying to conjecture on----
Mr. Gosar. It may--it may not be politically savvy or, you
know, like, as we say, red meat, but what you were doing is you
were very honest in regards to the process.
Mr. Gruber. Once again, I was making statements about which
I really didn't have the expertise to make--to make. I was just
speaking out of turn.
Mr. Gosar. Oh. I don't know about expertise. Let's go down
that.
We just talked about the beauty is in the detail. You're
very astute about the economic aspects. You had your
inclinations and models with Romneycare. You actually had these
models with Obamacare. So you're very astute in regards to
this.
I mean, being from MIT, I mean, that's one of the most
prestigious acclaimed environments in the world. Right?
Mr. Gruber. I believe so. Yes.
Mr. Gosar. And when you're proud of a product, you really
are vested in that product. So you're going to be very watchful
as it takes place, as it changes, as it morphs, and maybe as it
has contradictions. Right?
Mr. Gruber. I was very proud and invested in the modeling
and the numbers I produced. Yes.
Mr. Gosar. Yes. So I'm going to go back to it.
So you were very honest in your evaluation of what
transpired. We saw the real Jonathan Gruber in there. I mean, I
watched you last night for almost 4 hours on all the different
aspects. I read body language extremely well. So you were in
your element when you were talking about the critiques of this
healthcare law.
So let me ask you something. So who helped you with your
testimony today? And who signed off on your testimony today?
Mr. Gruber. No one signed off on my testimony. It's my own
testimony. I did receive assistance from my counsel.
Mr. Gosar. Did you also have assistance from HHS? The
administration? The minority staff committee?
Mr. Gruber. No, I did not.
Mr. Gosar. Okay. Now, were you coached in any way what to
say?
Mr. Gruber. I--the words that are written I said are my
own. As I said, I did work with my counsel in preparing them.
Mr. Gosar. Okay. So when we had numbers of my colleagues
asking you in regards to numbers, you're pretty astute with
numbers. Right? You know those numbers?
Mr. Gruber. Once again, the numbers that I produced in
terms of my micro-simulation modeling I'm very confident in.
Mr. Gosar. Ms. Tavenner, you're also pretty good with
numbers, aren't you?
I mean, I've been watching the bantering back and forth.
And when the other side asks you a question, you're very
prepared with numbers, but when we ask you a question, you're
very inappropriately responsible to numbers.
But you're very good with numbers because you hear them all
day long; do you not?
Ms. Tavenner. I do hear numbers.
Mr. Gosar. You do. I agree. I agree.
So, you know, this preponderance of looking at the falling
rate of dollars being spent on health care--I want to go back
to the microcosm called dentistry.
Did anybody even think about this? I mean, what kind of
access--and the gentlelady from New Mexico talked about access.
Did that ever come into your aspect, that the deductibles are
so high in the dental aspect that no one's using them? Did that
ever occur to you?
Ms. Tavenner. You know, if you look at what we did around
the dental proposed in final rule last year, we actually tried
to make some accommodation there to handle the deductible, to
improve it, if you will.
Mr. Gosar. Well, that's nice, I mean, you know, changing
around some of those aspects. But, you know, from my
standpoint, when people don't actually get care, you're
actually creating a bigger problem.
You know, the gentleman from Maryland is aware of the
Deamonte Driver aspect. When people can't pay for it, it
reduces access. Children go walking around without getting
health care, and all of a sudden we have that child that dies.
You're aware of that situation?
Ms. Tavenner. Yes. I'm aware of the situation that
occurred.
Mr. Gosar. So, once again, it becomes that fluff part, you
know, because I heard people on the other side over here saying
this was the most transparent process. Really? It didn't
involve anybody on this side.
And I'm very well aware of having, you know, a bipartisan
type of application to health care. Because health care's a
personal sport. The patient has to be involved. And it's not a
Republican or Democratic issue, but it became a very Democratic
issue.
They used reconciliation and a lot of gimmicks to pass it.
We were deceitful in everything that we've done, I mean,
everything. Instead of acknowledging the problems and being
truthful on it, we heard tortured language, you know, from the
gentleman to your left.
This was outright the wrong way to go. So from that
standpoint, it sickens me to actually hear what I heard today
from both you and from Mr. Gruber. It's sad, you know, that
we're playing with people's health care when they deserve
something better.
And, frankly, not having the facts is disdainful. Congress
has a right to those facts. We've seen this perpetually with
this administration from Fast and Furious to Benghazi, to here,
to the IRS. It's disdainful. Equal branches of Government
should have that opportunity, and the American people deserve
better from both of you.
Thank you.
Chairman Issa. Thank you.
Was there an answer? Okay.
We now go to the gentleman from Pennsylvania, Mr. Meehan.
Mr. Meehan. Thank you, Mr. Chairman.
Mr. Chairman, I want to express my appreciation to you and
the ranking member for your leadership of this committee over
the course of the years.
I want to thank the folks for being here today.
I mean, I know there's a lot of characterizations of
testimony and what things have gone on. We go back and forth on
this committee. I mean, I know in the end--and I think you
would agree--in the end, our--the people we represent, the
American consumers, aren't--I find to be actually quite
intelligent with their efforts to try to become good consumers
of healthcare information.
And these aren't ``gotcha'' questions, but we don't get a
chance to have you before us much, Ms. Tavenner. And what I'm
seeing out there right now is patients who are--they are the
holders of their electronic health records, but they're
bouncing around from system to system.
I mean, they are frustrated. Their costs are rising. They
aren't getting the access to the doctors they had before.
They're paying more out of cost, which I think is one of the
factors that's driving some of the containment of health care.
But at the same time, what's happening is I think people aren't
getting health care. They're going to be paying more for it
down the road.
But my problem is: How are we working on assuring that
these systems of electronic health records can communicate
through the larger structure? It seems if you're in a health
system, you can do okay. They'll send records down to your doc
and, you know, pre--with this whole idea of the medical home,
but if you have a surgeon outside of another network, it
doesn't seem the systems are communicating with each other.
Everybody's saying, ``Use my system.''
What are we doing? How are you working to try to break
through those adhesions so we can get to a point where we can
allow consumers to be much better in helping them guide their
health care and negotiate through the systems, whomever the
health care provider is?
Ms. Tavenner. I think what you're talking about with the
issue of interoperability is one of our remaining challenges.
You're right. We have strong systems within a system.
Physicians and hospitals tend to work together well, but when
we are moving across systems, that's still a challenge.
And that's part of--as we look at Stage 3 of meaningful
use, one of the big pieces that we are going to stress is this
whole issue of interoperability.
We have some pilots now. We have some examples. But the
question is: How do we get that to the mainstream----
Mr. Meehan. Do you have--I mean, can you give me some sense
right now? Because that does appear to be and I think it's
going to continue to be if we don't find a way.
Because, look, people move. They're here today. My elderly
will be down--they may go away for 2 or 3 months in the
wintertime now to different physicians.
Ms. Tavenner. So I see it happening in two ways. One
obviously is with payment strategy because that tends to work.
The second is with our certification requirements.
So we'll be working with the Department, with HHS and CMS--
because this is kind of a two-group effort--to make sure that
we put in our certifications and other requirements, those
measures that will push interoperability. Because I agree with
you. It's critical.
Mr. Meehan. And from the perspective of the patients, then,
are we doing more to be able--or how are you helping us to be
able to understand what they're going to face in premiums or
out-of-pocket costs or provider quality, in particular? How are
you moving to be allowing the patient to become a better
consumer?
Ms. Tavenner. So that is--again, we spent a lot of 2014
just helping people sign up, and now the second part is how do
you educate those individuals who've signed up.
So we have started work that we're doing. It started within
CMS. We're now putting it more broadly out to the consumer.
It's called From Coverage to Care, so helping people
understand what deductibles are, what co-payments are, how
they--one thing that's greatly misunderstood is that
individuals don't pay co-pays and deductibles for preventive
care and for other types of procedures that are preventive in
nature.
Mr. Meehan. Well, certain kinds. But, I mean, there's a lot
of care----
Ms. Tavenner. Yes.
Mr. Meehan. --that they----
Ms. Tavenner. Yes, there is.
Ms. Meehan. --do. And, unfortunately, that's often when
they're----
Ms. Tavenner. Right.
Mr. Meehan. --going to see the physician.
Ms. Tavenner. So that's how we'll start. And we'll work
with issuers, we'll work with advocates, to get the education
out there to help people understand it. It's pretty
complicated.
Mr. Meehan. Well, it is complicated, and particularly for
the consumers themselves. There's a lot more. I don't agree
with the way the system's set up, but that is really
fundamentally for working where we've got to make significant,
significant improvements. And I hope you continue to focus on
that----
Ms. Tavenner. We are focusing----
Mr. Meehan. --as a prospective direction.
Ms. Tavenner. --on consumers. I agree with you.
Mr. Meehan. Thank you.
Chairman Issa. Would the gentleman yield?
Mr. Meehan. Yes.
Chairman Issa. I'm going to ask unanimous consent that the
publication, ``Data-Mined: Numbers You Can Use,'' be placed in
the record. Without objection, so ordered.
Chairman Issa. Ms. Tavenner, I just want to make sure I get
this right.
According to this article, healthcare costs are up, as you
said, about 3--you know, a little under 4 percent. But in order
to get that figure, utilization is down.
So the total amount of services dropped off and the costs
per services went up, meaning if you need services, they went
up a lot more than 3 percent.
The cost of service, of total expenditure, didn't go up as
much because people are essentially not buying as much. Isn't
that true?
Ms. Tavenner. I don't believe that's true.
Chairman Issa. Do you know that it's not true or are you
just saying that you just don't want to believe that? Maybe
your staff can tell you that, in fact, this is pretty well
authenticated.
Ms. Tavenner. Well, I'd have to see the article. I haven't
seen the article.
Chairman Issa. So you don't know if, in fact, healthcare
costs are up and utilization of services are down, particularly
because people have higher out-of-pocket expenditures?
Ms. Tavenner. Well, I----
Chairman Issa. You don't know that, do you?
Ms. Tavenner. If you'd let me finish my sentence, what
we're seeing on the in-patient side is that in-patient
admissions are down, which may mean more appropriate use of
services, not necessarily that it's bad.
Chairman Issa. Okay. So you know that services are--
quantity of services are down, and your conjecture is that it
might be a good thing?
Ms. Tavenner. I think it can be a good thing. Yes.
Chairman Issa. Thank you. I'll accept that that's your
conjecture.
We now go to Mr. Gowdy for his 5 minutes.
Mr. Gowdy. Thank you, Mr.----
Chairman Issa. Oh. I'm sorry.
Is the gentleman-- he yielded to me.
Okay. Mr. Gowdy. Oh. Mr. Amash has returned.
I apologize, Mr. Gowdy.
Mr. Amash is recognized for 5 minutes.
Mr. Amash. Thank you, Mr. Chairman.
Thank you, Mr. Gowdy.
I have a question for Dr. Gruber concerning tax credits.
Dr. Gruber, at a conference in 2012, you said, ``If you're
a state and you don't set up an exchange, that means your
citizens don't get their tax credits.''
That statement was consistent with other public statements
you made, all of which expressed your belief that, if a State
refused to set up an Obamacare exchange, the citizens of that
State could not qualify for Obamacare tax credits, yet the
administration has ordered the distribution of billions of
dollars to persons who live in States that don't have state-run
Obamacare exchanges.
This executive action seems to conflict with your numerous
past statements about how Obamacare works. There's a lawsuit
before the Supreme Court on this issue.
In your testimony this morning, you claimed that you
misspoke repeatedly in your prior public statements. You say
that, ``The point I believe I was making was about the
possibility that the Federal Government, for whatever reason,
might not create a Federal exchange.''
You further explained this morning, in response to Mr.
Connolly's question, that you think the administration can
choose whether or not to create Federal exchanges in States
that refuse to set up those exchanges. So if a State refuses to
set up an Obamacare exchange and the Federal Government refuses
to set up an Obamacare exchange, then citizens of that State
can't receive Obamacare tax credits.
Dr. Gruber, your new explanation of your previous public
statements makes little sense.
The law requires the Federal Government to create Obamacare
exchanges in States that refuse to create the exchanges for
themselves. Therefore, every State must have an Obamacare
exchange either set up by the State or the Federal Government.
If that's the case, then every State must have an Obamacare
exchange.
What did you mean when you repeatedly said that the
citizens of some States may not qualify for Obamacare tax
credits? Isn't it the case, as you said previously, that people
who live in States without a state-run exchange consist receive
Obamacare tax credits?
Mr. Gruber. Once again, when I made those comments, I
believe what I was saying was reflecting uncertainty about the
implementation of a Federal exchange by January 1st, 2014.
Mr. Amash. Are you suggesting that the law doesn't require
the Federal Government to set up an exchange in States that
don't have exchanges?
Mr. Gruber. I don't recall exactly what the law says. What
I'm saying is there were certainly----
Mr. Amash. I'm sorry.
You ran the economic model on Obamacare and you don't know
what the law says?
Mr. Gruber. In every single economic model I ran, I always
assumed that exchanges--credits would be available regardless
of whether the exchange is run by a State or the Federal
Government.
My comments in January of 2012 were reflecting the
uncertainty about whether those Federal exchanges might be
ready by January 2014.
Mr. Amash. So you were paid hundreds of thousands of
dollars to run an economic model on Obamacare and, yet, you
were making statements that didn't reflect the actual language
of Obamacare?
Mr. Gruber. I made a series of statements which were really
just inexcusable.
Mr. Amash. All right. Thank you.
Chairman Issa. Would the gentleman yield?
Mr. Amash. I yield back.
Chairman Issa. Would the gentleman yield?
Mr. Amash. Yes.
Chairman Issa. I just want to make sure I understand.
We famously heard that you have to pass it to find out
what's in it. So following up on Mr. Amash, at the time of its
passage, were you aware that the language would have allowed
your model not to actually be executed, in other words, that
States were not going--if they chose not to--if even one State
chose not to provide, the language explicitly was preventing
that reimbursement and, thus, you'd have a different result?
Were you ever given that information so you could run a revised
model?
Mr. Gruber. I was always modeling the availability of tax
credits under the assumption they'd be available in all States.
Chairman Issa. Okay. So you always modeled something that
was different than the law and--but let me just go and do one
quick thing while I've got the time.
You're an author, and I've purchased one of your books. In
that book, it's, ``Dr. Jonathan Gruber is a Professor of
Economics at the Massachusetts Institute of Technology and
Director of the Healthcare Program at the National Bureau of
Economic Research. He was a key architect of Massachusetts'
ambitious healthcare reform effort and consulted extensively
with Obama Administration and Congress during the development
of the Affordable Care Act. The Washington Post called him
possibly the Democratic (party's) most influential healthcare
expert.''
Do you recognize that as being in your book?
Mr. Gruber. Yes, I do.
Chairman Issa. Okay. And then it--so if you--if you're an
author, you put it in your book and you recognize it, do you
stand by it?
Mr. Gruber. Absolutely.
Chairman Issa. So you are, in fact, a key architect of the
act in Massachusetts under Governor Romney and that you did--
you did contribute extensively to the administration and to
Congress?
Mr. Gruber. I contributed an enormous amount of modeling
and economic support to the administration and Congress. Yes.
Chairman Issa. You can--it says ``and consulted extensively
with the Obama Administration and Congress during the
development of the Affordable Care Act.'' That's----
Mr. Gruber. That's provided----
Chairman Issa. And you quoted The Washington Post.
And you stand by all of that.
Mr. Gruber. I--I cannot stand by the Washington Post's
opinion of my role in the Democratic party, but I can certainly
stand by the fact that I provided an enormous numbers of hours
in----
Chairman Issa. Well, you put it in your book. Right?
Mr. Gruber. I was quoting--it was a flattering quote to me
and I put it in my book, but it's their definition, not mine.
Chairman Issa. So you want to stand by something you put in
a book, including the ``consulted extensively with the Obama
Administration and Congress,'' but now you want to distance
yourself from The Washington Post?
Mr. Gruber. I'm just saying it wasn't my words. I put them
in quotes because they're Washington Post's words.
Mr. Smith. Oh. Oh, okay. So we'll--we'll let The Washington
Post's credibility speak for itself. I thank you.
We now go to Mr. Gowdy.
Mr. Gowdy. Professor Gruber, what did you mean when you
said, ``They proposed it and that passed because the American
people are too stupid to understand the difference''?
Mr. Gruber. When I said that, I was at an academic
conference, being glib and, quite frankly, trying to make
myself seem smart by insulting others.
Mr. Gowdy. Are you offering the venue as a defense for--for
saying it or for meaning it?
Mr. Gruber. I'm offering it as a defense for using
inappropriate and hurtful, inexcusable language to----
Mr. Gowdy. Well, what did you mean by ``too stupid to
understand the difference''?
Mr. Gruber. Congressman, I didn't mean anything about it--
by it.
Mr. Gowdy. Well, you said it. You had to have meant it.
Mr. Gruber. I was, once again, being glib and trying to
make myself seem smarter by reflecting----
Mr. Gowdy. Well, what did you mean when you said it was ``a
very basic exploitation of the lack of economic understanding
of the American voter''? What did you mean by that?
Mr. Gruber. Once again, it's another example of my
inexcusable arrogance in trying to insult others to make myself
seem smarter.
Mr. Gowdy. Well, what did you mean when you said, ``The
American people don't care about the uninsured''?
Mr. Gruber. Once again, that was an overstatement of trying
to conjecture on political topics on which I'm not an expert.
Mr. Gowdy. Well, you know what, Professor Gruber? I have
listened to you all morning talk about your lack of political
acumen and that you're not a politician; so, therefore, you
don't know not to call people stupid. Most of the people
watching this morning aren't politicians and they don't call
people stupid.
And I can't help but note, Professor Gruber, in another one
of your quotes, which I'll read to you, ``That was politically
infeasible''--do you remember saying that?
Mr. Gruber. Yes.
Mr. Gowdy. So you do like to factor in the politics from
time to time, don't you? And I also happen to note, Professor
Gruber, that, usually, you insult the American voter, not the
American public. So you do factor in politics, don't you?
Mr. Gruber. I have tried--a number of occasions pretended
that I know more about politics than I did.
Mr. Gowdy. Do you think not being a politician is a
defense? Is that your defense this morning?
I mean, I know initially you said that you offered these
comments at a conference--I think you meant conferences,
plural, but you said conference--when you went on a very
obscure television show and initially apologized for what you
said were inappropriate comments.
And now today your defense is that you're not a politician.
Is that the best you can come up with?
Mr. Gruber. The best I can come up with is to really just
apologize for an inexcusable and----
Mr. Gowdy. Well, but I want to know--I mean, the
pervasiveness of your quotes is so much that it has to be more
than that. It has to be more than just an episodic mistake that
you made.
Well, here. Let me keep going. See if this helps you any.
What did you mean when you said you wished that you had
been able to be transparent, but you'd rather have the law than
not?
Mr. Gruber. Once again, it was my trying to conjecture
about a political process in which I'm not an expert.
Mr. Gowdy. Well, what did you mean when you said it was
written in a tortured way to make sure the CBO didn't score the
mandate as a tax?
Mr. Gruber. Once again, it was using inappropriate language
to try to sound impressive about something to my colleagues.
Mr. Gowdy. Do you see a trend developing here, Professor
Gruber?
Mr. Gruber. I don't understand the question.
Mr. Gowdy. It's a lot of stupid quotes you've made. That's
the trend.
Mr. Gruber. A lot of----
Mr. Gowdy. Do you see them?
Mr. Gruber. --inexcusable quotes. Yes.
Mr. Gowdy. Right.
And, again, your defense is that you're not a politician.
The lack of transparency is a huge political advantage.
Well, what is a non-politician doing talking about
political advantages?
Mr. Gruber. A non-politician is talking about political
advantages to try to make himself seem smarter by conjecturing
about something he doesn't really know about.
Mr. Gowdy. So you're a professor at MIT and you're worried
about not looking smart enough?
Mr. Gruber. Yes.
Mr. Gowdy. Okay. Well, you succeeded, if that was your
goal.
Now, I want to ask you: Are you sorry--when did you realize
that these comments were inappropriate? Because it took you
about a year to apologize.
So I'm trying to figure out if you realized sooner that
they were inappropriate or--or was it just the morning before
you went on MSNBC that you realized that it was inappropriate.
When did you realize that these comments are indefensible and
inappropriate?
Mr. Gruber. I honestly didn't remember making them.
Mr. Gowdy. You didn't remember calling your fellow citizens
stupid and you didn't remember saying that you're the only
person who cares about the uninsured and that the rest of your
fellow citizen don't give a damn about the uninsured? You don't
remember saying that?
Mr. Gruber. I don't. Because they were really glib and
thoughtless comments that I made.
Mr. Gowdy. Well, Professor Gruber, let me just tell you
what it looks like from this vantage point, is that you thought
that they were really pithy and really funny until the video
showed up. And then--even then it took you a little while to
apologize.
And what I'm struggling with is whether your apology is
because you said it or because you meant it. Which are you
apologizing for, because you said it or because you meant it?
Mr. Gruber. I didn't mean it. I'm apologizing----
Mr. Gowdy. All of these quotes that I just read to you, you
didn't mean a single one of them, not a one?
Mr. Gruber. What I've--what I said, Congressman, is that I
was using glib, thoughtless, and really inexcusable language to
try to----
Mr. Gowdy. Well, you used them a lot. You used them a lot,
Professor Gruber, which tends to undercut the notion that you
were sorry for an episodic misstatement. I just read to you
about ten.
Do you see why people might possibly think the apology is a
little disingenuous, maybe?
I yield back, Mr. Chairman.
Chairman Issa. Will the gentleman yield me just 10 seconds?
Following up----
Mr. Gowdy. Certainly.
Chairman Issa. --on Mr. Gowdy, when you made these repeated
comments, these glib, inappropriate comments, in an
intellectual community with lots of other like-minded people,
did anybody come up to you and tell you that what you were
saying was inappropriate?
Mr. Gruber. Not that I can recall. No.
Chairman Issa. I guess what you said was popular in that
community.
We now go to the gentleman from Texas, Mr. Farenthold.
Mr. Farenthold. Thank you very much.
Dr. Gruber, you have the dubious distinction of having
generated more buzz in the district that I represent than
anybody but Eric Holder when coming up before this committee.
And so I apologize if some of my questions are disjointed.
Several of them come from Twitter, from folks who wanted me to
ask you a question.
One I got was, ``Why won't he answer the question?'' But
I'm going to translate that more into--put my lawyer hat on and
reask that.
With respect to questions about the money that you made
consulting on Obamacare from the both Federal and state
government, you've constantly lawyered up or not answered the
questions or not recalled. I want to be perfectly clear. This
committee has government-wide jurisdiction. We are the taxpayer
watchdogs.
I am asking you right now flat out to provide a detailed
list of every penny of taxpayer money that you have made from
the Government consulting on Obamacare, be it from the Federal
Government, be it from the State on a federally funded grant,
or from a State.
I am asking you to provide that within 30 days, and I would
look forward to you providing it to the committee. And we'll
work with Mr. Chaffetz, the incoming chairman, to subpoena that
if it's not supplied voluntarily.
So let me go on to some--a couple of questions.
Do feel bad about taking all this money from Obamacare from
people you call stupid?
Mr. Gruber. The money that I received for my economic
consulting work was compensation for the quality work I did in
economics and modeling. And so I think it was appropriate.
Mr. Farenthold. Okay. Do you--you worked--you had 21
meetings at the White House. You met once in the President's
office. You talked to him.
Based on what--the information you provided, things you
heard in this meeting, your--these meetings, and your general
understanding, do you believe that the administration was
truthful and transparent in the things they said working up to
the passage of Obamacare, like, if you like your healthcare,
you could keep it?
Mr. Gruber. I believe that the discussion of the Affordable
Care Act was fully transparent, and there was enormous
discussion of many--of all of the aspects of the law.
Mr. Farenthold. Do you feel like--well, now, you testified
earlier that you knew there was going to be some churn.
Do you feel like you were complacent in presenting the
Affordable Care Act in a dishonest or untruthful manner? And is
that something you would like to apologize for as well?
Mr. Gruber. The numbers that I presented as part of my
economic modeling to the administration and Congress were all
to the--my best of economic--my economic modeling ability.
Mr. Farenthold. But you knew some of the things that the
administration were saying, some of the things in the debate,
were not true.
Why didn't you raise a red flag? Wouldn't that make you
complacent?
Mr. Gruber. I'm--I'm not a political advisor. It's not my
job to discuss what the President's saying or not saying.
Mr. Farenthold. Let me--just another question from Twitter.
Did your insurance get more expensive? Are you paying more
for it? Is your--did your deductible go up?
Mr. Gruber. Health insurance costs in America have gone up
every year for the past 50 years.
Mr. Farenthold. Did yours go up substantially more when you
fell under the Affordable Care Act than it had in past years?
Mr. Gruber. No, it did not.
Mr. Farenthold. Mine sure did.
Let me see. Where else do I want to go?
When you were talking to Mr. McHenry, you said that the
Affordable Care Act did not solve the problem of rising health
insurance costs. You went on to say that it was a first step.
What are the next steps?
Mr. Gruber. The next step really, in my view, is to learn
from the first steps that are implemented by the Affordable
Care Act, to learn what's working, what's not, and to try to
build on that towards stronger cost controls in the long run.
Mr. Farenthold. So if you were to sit down and write a
new--Affordable Care Act 2.0, what would be the top two or
three things you would want to include in it?
Mr. Gruber. Right now the number one thing I would say is
that we need some time to see what is happening with what we
did in Affordable Care Act 1.0, to learn from that, and then to
not be in a rush, but, rather, to sit down, having learned from
that, and take the next necessary steps.
Mr. Farenthold. Would you consider the ultimate solution to
rising healthcare costs to be a single payer or government-run
system--a completely government-run system?
Mr. Gruber. I don't think there is a single ultimate system
to rising healthcare costs.
Mr. Farenthold. All right. And you've also been thrown
under the bus by the President as just another--another
advisor. I think I would be insulted by that, based on the--
certainly by the Washington Post article that, you know, said
how--how key you were to that.
Mr. Farenthold. You want to come clean and just tell us if
you told them any of things that they were saying were untrue
and who you told stop them? Kind of loops back into my--my
complacency question. Could you have stopped some of those
untruthful statements? And why didn't you? And would you like
to apologize for not doing that?
Mr. Gruber. I am not a political adviser.
Mr. Farenthold. All right. Well, I'll yield back. Thank
you, Mr. Chairman.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from the Massachusetts Institute
of Technology, Mr. Massie--and Kentucky for that matter, too.
Mr. Massie. Yes, Kentucky. It's been a bad few couple of
months to be from MIT, thanks to one our witnesses.
I've reviewed your extensive and impressive curriculum
vitae. It's 17 pages long. And would it be accurate to say that
you chose economics, particularly the field of economic models,
to inform public policy as a--as part of your career?
Mr. Gruber. Certainly one of the things I find appealing
about economics is how it can make informed public policy.
Mr. Massie. So you're in an a position of trust. You've
been to the White House many times. You've met with the
President. Could you tell us again what you met with the
President about?
Mr. Gruber. I had one meeting with the President. There
were six experts and about 15 other members of the
administration.
Mr. Massie. And you were an expert on the--how to control
the costs.
Mr. Gruber. Yes. The actual costs and also to discuss
healthcare reform in Massachusetts and how it worked.
Mr. Massie. Was an Independent Payment Advisory Board part
of the that discussion or is that something that you would be
an expert on?
Mr. Gruber. I don't believe the Independent Payment
Advisory Board existed at that meeting.
Mr. Massie. Okay. But you're very well aware of it and
advise politicians on that.
Mr. Gruber. I'm aware of the Independent Payment Advisory
Board, yes.
Mr. Massie. So given this position of trust and the fact
that you take taxpayer money, I have a question for you.
Have you had any ethics training at MIT or Harvard?
Mr. Gruber. As a condition for receiving Federal grants, we
have to take a human subjects test on ethical issues.
Mr. Massie. And MIT has an ethics policy; correct?
Mr. Gruber. Yes.
Mr. Massie. So this is a little bit philosophical, what I'm
going to ask you now. But you're a doctorate of philosophy, so
to speak.
Under what circumstances is it ethical to deceive someone
for their own benefit?
Mr. Gruber. I'm not aware of circumstances in which that's
true.
Mr. Massie. Could you imagine maybe an adult could withhold
information from children for their own benefit?
Mr. Gruber. Yes.
Mr. Massie. Would there be ethical--now, so if you
understand that, you understand why my constituents are so
offended by your proposition that it's okay to deceive or
obfuscate for somebody's benefit. Compounding the insult that
you delivered to them is the fact that they pay your salary.
So do you understand fully why it was so insulting? You
patronized them. You were condescending.
Mr. Gruber. I was, I agree.
Mr. Massie. And my colleagues on the Democrat side of the
aisle are upset with you simply because you committed candor.
You said what you thought. You said what they were all thinking
when they wrote Obamacare, that they knew what was best for my
constituents.
I submit to you my constituents are not your children they
have the right of self-determination.
So this gets me to another instance where you committed
candor.
In 1997, you coauthored a paper entitled ``Abortion
Legalization and Child Living Circumstances: Who is the
Marginal Child?''
On page 20, you conclude that abortion legalization appears
to be associated with an improvement in the average living
circumstances and birth outcomes among a birth cohort.
And on page 26, you state that your research indicates that
the legalization of abortion saved the government $14 billion
in welfare payments through 1994.
Is providing more access to abortion, is that a worthy
social outcome to achieve cost savings for the government?
Mr. Gruber. That is not what my paper was about. It wasn't
a philosophical paper. It was about empirical facts.
Mr. Massie. Tell me what you meant by this sentence: By
1992, all cohorts under the age 18 were born under legalized
abortion, and we estimate steady State savings of $1.6 billion
per year from positive selection.
What did you mean by ``positive selection''? Because in
this paper, you're talking about providing more access to
abortions to a socioeconomic strata of our constituents.
Mr. Gruber. What the paper did was look at----
Mr. Massie. What did you mean by ``positive selection'' in
abortions?
Mr. Gruber. In that paper, we were studying the
characteristics of children who were born before and after
abortion was legalized. By comparing those characteristics, you
can infer the characteristics of the kids who were not born.
Mr. Massie. So what you inferred I find chilling. What you
inferred is that if we reduce the number of people or children
born, life will be better for the rest of us still living.
Specifically, you seem to suggest that if we eliminate or
reduce the number of poor people that are born, this will make
life better for all Americans.
And this gets me to my final point, which is, the
Independent Payment Advisory Board. My constituents fear that
this is, in fact, a method by which Obamacare will ration
healthcare for the elderly and, therefore, implement cost
savings for Medicare.
So my question to you is, does your philosophy on abortion,
that it can save money and improve outcomes, have any
implications in the realm of end-of-life care?
You argue that abortions of poor children raise the average
living circumstances in your paper for the rest of us and save
the government money.
So, Dr. Gruber, if there are fewer elderly people,
particularly poor elderly people, wouldn't that save a ton of
money, too? As an economist, wouldn't you think that would save
them money, too? And do you understand the dangerous
implications of going down this path?
Mr. Gruber. I have no philosophy of abortion. I have no
philosophy of end-of-life care. My job as an economist is to
deliver the empirical facts so that you all can make the
necessary----
Mr. Massie. What would your facts be on the elderly?
Mr. Gruber. I don't understand the question.
Mr. Massie. The end-of-life care. Do you advocate that the
Federal Government should ration that?
Mr. Gruber. No, I do not.
Mr. Massie. As an economist, would it save money?
Mr. Gruber. I do not advocate the Federal Government should
ration end-of-life care.
Mr. Massie. Thank you. I yield back.
Chairman Issa. I thank the gentleman.
We now go to the very patient Mr. Meadows.
Mr. Meadows. Thank you, Mr. Chairman. And it has been a
privilege to serve under your leadership, truly an honor.
Dr. Gruber, I'm going to come to you because you have made
over 20 statements this morning that you are not political. And
yet I think the American people that are viewing this this
morning, they would see your testimony is political. It is
contrived. It is orchestrated and, honestly, not transparent.
You have prepared for this testimony this morning with your
counsel. Is that correct?
Mr. Gruber. Yes.
Mr. Meadows. How many hours does it take to be transparent
and honest of preparation? How many hours of preparation does
it take to be honest and transparent with the American people?
Mr. Gruber. I don't understand the question.
Mr. Meadows. Why would you have to practice your testimony
in order to give an honest, transparent answer to the questions
posed to you today?
Why would you have to practice? Because you have practiced
because you said the exact same thing, ``glib,'' those words,
you know, they are not heartfelt. You've practiced that,
haven't you?
Mr. Gruber. I have practiced, but I disagree that they are
not heartfelt.
Mr. Meadows. Okay. So let me ask you about your economic
model. Because you said it was accurate. So how many in your
economic model, how many Americans would lose their health
care, could not keep their plan, as the President promised,
under your economic model?
Mr. Gruber. I don't recall the exact number.
Mr. Meadows. So you can recall all these other figures, but
you can't recall that one?
Mr. Gruber. No, I can't----
Mr. Meadows. Okay. Can you get that to us?
Mr. Gruber. Once again----
Mr. Meadows. Oh, you don't want to get that to us.
Mr. Gruber. Once again, that depends on----
Mr. Meadows. Can you get us the number in your economic
model of those that were not going to be able to keep their
health care? Simple yes or no.
Mr. Gruber. I don't know.
Mr. Meadows. So you don't have it in your model.
Mr. Gruber. I don't know whether I can or not. You'll have
to take that up with my counsel.
Mr. Meadows. Mr. Chairman, I see this witness as being very
reluctant to give honest answers. And it is very troubling, not
just to me but to the American people.
Ms. Tavenner, I'm going to go to you, because the
administration didn't want you to sit beside Mr. Gruber because
they were afraid that his lack of transparency would be
contagious, I guess, or you would be viewed in a different
model.
I'm troubled because I asked you some questions at the last
time you appeared before this committee. And I asked you at
that particular time about a rollout. And we went back and
forth, and why did you not delay it?
And your response to me, it says from Ms.--Well, I didn't
think it was possible the way the FFM was configured to do
that, nor did I think it was necessary.
Do you stand by that today?
Ms. Tavenner. I stand by the fact that I felt we were in
good position to roll out last October.
Mr. Meadows. Okay. I'm in--and I'd ask if you could put up
the slide, if the staff could put up the slide.
I'm in possession of an email stream from your second in
command and Mr. Todd Parks that goes back and forth. This email
stream was less than 48 hours before rollout. It was on
September the 29th. And in that, it says, Just so we're clear,
Ms. Tavenner decided in January that we were go going to go no
matter what. It goes on even further to say, Hence the really
cruel, uncaring march that has occurred since January when she
threatened me with demotion or forced retirement if I didn't
take it on.
Are you familiar with this email?
Ms. Tavenner. I was not copied on that email. I have since
seen that email.
Mr. Meadows. All right. So your number two person--because
in the email stream, if you've read all the stream, it was
indicating that you weren't ready and yet it didn't really
matter.
Ms. Tavenner. I don't happen to agree with that.
Mr. Meadows. So it does matter.
So, in that same email stream, We were putting together
hardware--we were installing hardware less than 48 hours before
a rollout, so we wouldn't have a crash on the rollout day.
Did you not see that as troubling, that we were installing,
with less than 48 hours to go, we were installing hardware that
wouldn't be tested?
Ms. Tavenner. We were installing hardware to increase
capacity.
Mr. Meadows. Right. I got the numbers.
And so but you don't see that that's troubling when you're
rolling something out that you wouldn't be ready when you're
going to put in a piece of hardware just less than 48 hours.
Ms. Tavenner. We had tested and we were increasing our
capacity to handle more volume.
Mr. Meadows. And so this Ms. Snyder, is she with you today,
or she was forced to retire?
Ms. Tavenner. She was not forced to retire. In fact, I--
during the time----
Mr. Meadows. Did she retire?
Ms. Tavenner. She has retired. Her choice.
Mr. Meadows. She just was not forced to retire.
Ms. Tavenner. She wasn't forced to retire.
Mr. Meadows. Let me close by this. I sent your staff the
information with regards to almost 4 million people that if
they do not re-enroll will get hit with the tax bill, some 10
to 12 months from now if they do not--because their benchmark
plan has changed.
Are you notifying those almost 4 million people that they
may get a tax bill if they do not re-enroll? Individually.
Ms. Tavenner. We are individually notifying folks about----
Mr. Meadows. That is funny. Because I have 17 counties I
represent and not a single one of them have gotten individually
notified that they are going to get a tax bill.
Ms. Tavenner. So they are individually notified--I did not
get a chance to finish my sentence.
Mr. Meadows. I'm sorry.
Ms. Tavenner. They have been individually notified that
they need to come back in to return to the marketplace to
update their information and make sure that, A, their
information is current, and, B, that they're selecting the
plan.
Mr. Meadows. That is a general marketing thing. You already
responded to that.
Ms. Tavenner. No, it's not a general marketing. It's an
individual letter and phone calls to folks.
Mr. Meadows. But, individually, you know who is not--who is
going to get a tax bill--you know that today--if they do not
re-enroll. So why do we not notify them that if they
automatically renew, they will get a tax bill?
Ms. Tavenner. Well, first of all, I don't know that that's
necessarily true.
Mr. Meadows. Well, talk to Dr. Gruber. Because it is a part
of the plan that your premium, the rebate you get, whether your
income changes or not, is based on selecting the benchmark
silver plan. If the benchmark plan changes--and I would think
that you would know that you're over this--if the benchmark
changes, then indeed what the amount of money that you get back
will be incorrect.
Ms. Tavenner. So the benchmark is just one thing that
changes, right? There's lots of other things that could change
that would change your tax liability or your tax surplus.
Mr. Meadows. I understand that. But what I am saying is
someone who makes the same amount of money, stays on the same
plan, got a rebate this last 11 or 12 months, they will get a
tax bill unbeknownst to them by doing nothing.
Ms. Tavenner. I think that you're assuming--I assume you're
talking about 2016, not 2015.
Mr. Meadows. So this open enrollment period right now.
Ms. Tavenner. That's not true.
Mr. Meadows. Why is it? Because I'm all ears. I want to
tell the folks.
Ms. Tavenner. First of all, the individuals who signed up
in 2014, if they have a tax liability or tax credit, that will
be in April of 2015.
Mr. Meadows. I understand that.
Ms. Tavenner. Individuals that you're talking about now who
are signing up for 2015, if they were to have a tax liability
at all, it would be in April of 2016.
Mr. Meadows. That's correct. That's what I'm saying.
They're going to get a tax bill if they do automatically renew,
by February, if they don't----
Ms. Tavenner. Not necessarily. It depends on what's going
on with the individual.
Mr. Meadows. So they could change their plan after
February.
Ms. Tavenner. They cannot change their plan after February.
But whether or not they have a tax liability is going to depend
on each individual. Which is why what you are trying to say is
a part of what we are stressing to individuals: Come back,
update your information, look at a plan, shop, select.
But every--when they did their original plan, they also
understood that they are to update income, changes in family
circumstances. There's lots of things that can affect.
Mr. Meadows. I understand that.
Ms. Tavenner. That's all I'm saying.
Mr. Meadows. But what I am saying is the benchmark plan in
the counties I represent will change because it's a different
carrier. If they do not go in and select the new plan, their--
--
Ms. Tavenner. First of all, if they don't select a new
plan, we don't move them to a new carrier.
Mr. Meadows. Right. They will be automatically renewed.
I appreciate the patience of the chair.
Chairman Issa. I appreciate the gentleman from North
Carolina. I think the gentleman made the point that every
American has to, independent--because he's not--he or she is
not getting this information from CMS--they have to
independently ask whether or not they are getting into a tax
booby trap, into a tax land mine by just automatically
renewing. And I think the gentleman's point is good.
I'm afraid Ms. Tavenner doesn't want to admit that some
people are simply not going to know. And she said, rightfully
so, well, it's their responsibility.
Well, it was never somebody's responsibility to know that
they might be getting into a tax consequence before the
Affordable Care Act. They now need to know that.
We now go to the gentleman from Michigan, Mr. Bentivolio.
Ms. Tavenner. Could I answer that? Because I think----
Chairman Issa. No, ma'am, you may not. There was no
question there. Honest. I was simply talking.
Ms. Tavenner. There's a piece of it missing.
Chairman Issa. I was talking to the gentleman--we'll give
you plenty of time. We're not going to end this thing until
you've had all your say, ma'am.
The gentleman from Michigan.
Mr. Bentivolio. Thank you very much, Mr. Chairman.
Mr. Gruber, Ph.D. from MIT. Correct?
Mr. Gruber. No. My Ph.D. is from Harvard University.
Mr. Bentivolio. Harvard. Another prestigious school as
well. And you teach at MIT?
Mr. Gruber. Yes, I do.
Mr. Bentivolio. Very prestigious school.
Myself, I graduated from a small college. My dad was a
factory worker. I had to work my way through college. But I
understand, very prestigious and congratulations.
But I want to go back. Earlier, there were some people on
the--you as well as Members of Congress stating that this was a
very transparent, this bill. And yet from the very beginning,
if I remember correctly, a lady got out up in front of the
floor of the Congress, and she said you got to pass it before
you can see what's in it. Do you remember who that was.
Mr. Gruber. I believe that's a quote attributed to Nancy
Pelosi.
Mr. Bentivolio. Correct. Thank you.
And yet it was 2,700 pages, original act. And if you read
that 2,700 pages, you're going to see a lot that says ``to be
determined'' in that bill. So the bill wasn't really complete.
So how can you have a bill, pass a bill before you can see
what's in it, and call that transparent? Because I didn't get
to see it--well, I wasn't here, but other Members of Congress
really couldn't see that.
And then we find out now that, while we were told that you
can keep your insurance and you like it, and we know that's a
lie. You can keep your doctor, and we know that's a lie. And
you can keep your hospital, and that's a lie. Lies on top of
lies.
And it is not really about health care either. It's a tax.
Premiums will be lower. And yet they are higher. Another lie.
So let's backtrack. You apologized today for some comments
you made in the video. Correct?
Mr. Gruber. Yes.
Mr. Bentivolio. And several times here you said you
apologize for insulting others to make yourself look smarter or
better than others. That's paraphrasing, but that's pretty much
what you said. Is that correct?
Mr. Gruber. Yes.
Mr. Bentivolio. You want to repeat what you actually said?
Go ahead.
Mr. Gruber. No. What you said is a good paraphrase.
Mr. Bentivolio. Pretty good. So let's be clear. You did not
apologize for helping the administration deceive the American
people on this healthcare act or for telling America the truth
in your video comments about how it was a fraud upon the
American people. Is that correct, sir?
Mr. Gruber. I think the Affordable Care Act was passed in a
highly transparent fashion with hundreds of hours of debate.
Mr. Bentivolio. But every single thing they promised was a
lie. How can you call that transparent? You didn't say, Well,
what we're about to do for you is not going to really do you
any good, you're not going to be--you're not going to keep your
doctor, you're not going to keep your hospital, your premiums
are going to go up. Why didn't you say that? You were the
architect, one of the architects. You created the model. Is
that model flawed?
Mr. Gruber. I did economic microsimulation modeling that I
believe----
Mr. Bentivolio. Simulation. So you actually created the
model to justify their conclusions.
Seems about what you did--I mean, you're a lot smarter than
I did.
Now here's an opportunity for you to come clean. Lies on
top of lies. This is what you have done. You have been a
coconspirator in defrauding the American people, and you
admitted it in two videos and comments that I saw on TV. And I
saw some here today.
In helping this administration deceive our citizens you
received grants and contracts from the government, for either
the Federal Government or the States. Was it closer to $2.5
million or $2.8 million you received over the course of
implementing this Obamacare?
Mr. Gruber. I don't recall the exact figures.
Mr. Bentivolio. You're an economist. You know the quotes.
You said in the book you wrote, you know how to balance a
checkbook, you know how to read a balance sheet. Was it $2.5 or
$2.8 million or more? Plus or minus $100,000.
Mr. Gruber. Once again, I don't recall the exact amount.
Mr. Bentivolio. You know what? It's about, lies, half
truths, and distortions.
Why are you continuing to help this administration deceive
the American public?
With that, Mr. Chairman, I yield back.
Chairman Issa. If I could have the time for just these 40
seconds. And I thank the gentleman.
You keep saying you don't recall. Do you not recall any
numbers at all? I haven't seen a number you can recall since
you gave us that approximately $400,000 in your opening
statement.
You're an economist. You work with numbers. Why is it that
every question that comes from this side of the dais we get a
``don't recall,'' Mr. Gruber?
Mr. Gruber. The $400,000 is the number I recall very well
because it's been may very public. The other contracts and
other things I received from States and the Federal Government
are numbers I don't have at my fingertips but numbers that, you
know, the committee can discuss with my counsel about what's
appropriate to reveal.
Chairman Issa. You know, you're making it very obvious that
we're not only goingto have to discuss with your counsel, we're
going to have to serve a subpoena. We're going to have to
demand these numbers. Because you're not even giving us a fair
estimate of the approximately $4 million that you said--you
said in your earlier statement, well, this is excess and it
didn't all come to me.
But you haven't answered one question about grants and
contracts. I never knew anyone in business who got even a small
amount of something that didn't know about the grant or the
contract gross value and then what they got from it. And it's
amazing that you haven't given us one number since that chosen
amount. And that is a little disturbing.
And I will caution you one last time as these individuals
ask their questions that the goal was to get completed here
today with sworn statements about numbers, to the best of your
recollection--approximate was good enough. But, you know, the
fact that every answer is, Well, discuss with my lawyer, puts
this committee in a position where it is very clear we're going
to have to do more discovery. And likely you're going to be
back here again under the new chairmanship.
So, Mr. Bentivolio, did you have one last question?
Mr. Bentivolio. Thank you very much, Mr. Chairman. Just one
last question.
I understand, according to Supreme Court, this is a tax.
Correct? It's a tax.
Mr. Gruber. As I said earlier, I don't believe the
individual mandate is a tax.
Mr. Bentivolio. Okay. But it's a tax for failing to engage
in commerce. Because if I don't engage in Obamacare, go on the
Web site, I'm going to be taxed or fined. Correct?
Mr. Gruber. The individual mandate assesses a penalty on
you if you don't provide health insurance unless you meet
certain exemption criteria.
Mr. Bentivolio. I'd like to find some other examples of
somebody being taxed for failing to engage in commerce. It's
kind of like me going into my local grocery store, walking
around and not buying anything, and a Federal agent is outside
the grocery store saying, Hey, we're going to tax you because
you didn't buy anything in that store.
Thank you very much, Mr. Chairman.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from Florida, Mr. DeSantis.
Mr. DeSantis. Professor Gruber, would you deny--it's been
reported that you have received $3, $4 even $5 million with
your contracts from the various State governments. Many of them
$400,000, $500,000 a pop.
Are you saying you have no recollection of that? And do you
deny those reports?
Mr. Gruber. What I'm stating is the amounts that been
reported are greatly in excess of what I received in particular
through Federal grants. But I don't know the exact----
Mr. DeSantis. Is it in the millions, though?
Mr. Gruber. Once again, I don't know the exact amounts.
Mr. DeSantis. Look, you really further undermine your
credibility. I would think you would be able to give us a
ballpark. I mean, it's going to be subpoenaed. We'll go through
the exercise. The American people will eventually get the
truth.
This idea of you denying that you're the architect of
Obamacare. I'm just wondering, you know, you've been lauded in
the press in the past as the architect. There's an article in
the New York Times 2012 dubs you ``Mr. Mandate.'' There's a
quote from it that said, ``After Mr. Gruber helped the
administration put together the basic principles of the
proposal, the White House lent him to Capitol Hill to help
congressional staff members draft the specifics of the
legislation.''
So that's more than just providing some numbers.
And so the question is if what you're saying is true today,
that you're not really the architect of the law in any real
sense, did you tell any of those reporters that they were
inflating your role back in 2009, 2010, 2011, and 2012?
Mr. Gruber. Yes, I did tell the reporters they were.
Mr. DeSantis. And were there any corrections ever made to
the record?
Mr. Gruber. I don't know.
Mr. DeSantis. Okay. Because this is pretty consistent media
treatment.
Now, you testified that the comments about eligibility for
tax credits if the State didn't create an exchange, that you
made that comment because you weren't sure the Federal
Government would actually set up an exchange. And that was in
Falls Church, Virginia, January 2012.
And that's your explanation for that. Correct?
Mr. Gruber. As I said at the time, I don't recall exactly
what I meant when I made that statement. Looking back at the
video and thinking about how I could have made that statement,
I believe that's what I had in mind.
Mr. DeSantis. Because, it's interesting, if you go further
on in your comments, you say, ``The Federal Government has been
sort of slow in putting out its backstop. I think''--meaning
you think--``partly because they want to sort of squeeze the
States to do it.''
So that was the comment that you made. And so even under
that construction, you're saying that the Federal Government is
deliberately slowing the creation of the exchange so that more
States will do it, ergo, there must be a consequence for the
States if they do not do that.
So I don't think your explanation here today really
resolves that. I think you still have made comments from your
perspective in terms of what you want to do politically are
still problematic.
With some of the other comments you were making with this
lack of transparency, I just want to be clear. What you were
trying to say, I think, is that the bill is convoluted. You
agree it's a very confusing statute. Correct?
Mr. Gruber. It's a very complicated piece of legislation.
Mr. DeSantis. And the reason why it had to be written that
way is, if you were straightforward about imposing costs on one
American and then giving benefits to other Americans, that
would have run into political difficulty.
And so the costs are still being shifted to other
Americans, but they're being shifted under Obamacare indirectly
in a way that essentially masks what's happening.
Is that--is that basically the deal?
Mr. Gruber. That is a very broad statement. I generally
don't agree with what you just said.
Mr. DeSantis. So you don't believe that Obamacare's
convoluted nature serves to mask the true costs to individual
policyholders?
Mr. Gruber. No, I do not.
Mr. DeSantis. So when people are paying more for their
premiums--and you did a report to Wisconsin in 2011, and you
estimated, even though you had said in 2009 that premiums would
go down across the board under Obamacare, your report to
Wisconsin in 2011 said actually individual market premiums will
go up on average 30 percent relative to what they would have
been had Obamacare not been passed.
Mr. Gruber. The report I did for Congress was interpreting
CBO numbers, not my own, which discussed the fact that premiums
would rise----
Mr. DeSantis. But the report to the State of Wisconsin said
that they were going to rise. Correct?
Mr. Gruber. After tax credits, they fell on average. That's
what my report showed in Wisconsin.
Mr. DeSantis. You said the average premium. Most Americans
don't get tax credits, though. So the average premium increased
in Wisconsin. Correct?
Mr. Gruber. That was referring to individual market in
which most--most Wisconsinites will get tax credits.
Mr. DeSantis. But many of them won't.
So thank you. I yield back.
Chairman Issa. Thank you.
We now go to Mr. Collins for his round of questioning.
Mr. Collins. Thank you, Mr. Chairman. I appreciate the time
and the opportunity to be here.
Mr. Gruber, words cannot express today basically I,
frankly, didn't think it could get worse. Congratulations. You
got worse. Coming in here with the attitude that you've had and
I talk to my attorney about money I've earned.
Did you actually file a tax return last year? Did you
actually have to qualify your income?
Frankly, I and the American people--I am good to know one
thing that--and my implication of voters who did not like the
Obamacare plan, did not vote for it, were probably not the
stupid ones. And so my district, which voted against the
President almost 80 percent, is full of what you would consider
nonstupid people. I'm done with you.
Ms. Tavenner, got a couple of questions. And I'm going to
go fairly quickly here. Let's run through these.
How much money was paid to insurers under the Affordable
Care Act program known as to the cost-sharing reduction program
in fiscal year 2014?
Ms. Tavenner. I don't have that information----
Mr. Collins. Were you not briefed?
Ms. Tavenner. On the cost-sharing payment?
Mr. Collins. How much money was paid in 2014?
Ms. Tavenner. I have not been briefed on that, no.
Mr. Collins. You do not have reports that could get you
that information?
Ms. Tavenner. I can get you that information.
Mr. Collins. Are you in charge of this program?
Ms. Tavenner. I am in charge of this program.
Mr. Collins. And you do not know how much is paid out?
Ms. Tavenner. I do not have that with me today.
Mr. Collins. Do you have someone that can find that
information while they are handing you notes from behind?
It is amazing to me you run a program that is this large
that you can't answer questions. You and Mr. Gruber don't need
to sit beside each other because it is wearing off.
Number two, how much money is paid to insurers under the
cost sharing program reduction--Cost Sharing Reduction Program
in fiscal year 2015 to date?
Ms. Tavenner. I don't have that information.
Mr. Collins. Are you not briefed with this? Did you not get
a spreadsheet, a monthly spreadsheet?
Ms. Tavenner. I will be glad to get you that information.
Mr. Collins. Not my question. Answer my question. Do you
get a briefing on this?
Ms. Tavenner. Do I get a briefing----
Mr. Collins. Do you get a briefing that resembles something
of this effect where they are actually asking for it on a
regular basis?
Ms. Tavenner. I do get briefed.
Mr. Collins. Okay. Do you listen during those briefings?
Ms. Tavenner. I try to listen. I have a lot of information
to listen to----
Mr. Collins. So do I. So do I. But when you're also
subpoenaed--brought here to a hearing----
Ms. Tavenner. I was not subpoenaed.
Mr. Collins. You came in voluntarily. Thank you for that.
Ms. Tavenner. Thank you.
Mr. Collins. But the problem we have here is there seems to
be when we get here, we only want to answer the questions we
want to answer; -not questions that are part of your regular
job.
Let's continue on. The Wall Street Journal recently
reported that insurers participating in the 2015 ACA exchanges
insisted that their contracts contain a clause permitting
termination of contracts if the cost-sharing payments or
refundable tax credit payments cease.
Number one, is this report accurate?
Ms. Tavenner. There is information in the contract, and
I'll be glad to get you that.
Mr. Collins. So that would be yes?
Ms. Tavenner. I believe I said, yes.
Mr. Collins. No, you didn't.
Who negotiated these contracts with the insurers?
Ms. Tavenner. It's done by staff and attorneys within CMS.
Mr. Collins. I didn't hear your mic on.
Ms. Tavenner. It is done by staff and attorneys within CMS.
Mr. Collins. Do you approve those?
Ms. Tavenner. I do not approve individual contracts, no.
Mr. Collins. Will you provide for this committee the names
of those who negotiated these contracts with the attorneys?
Ms. Tavenner. I would be glad to get you information.
Mr. Collins. And I'm--and I'm going to just ask the
question not to honestly be funny here, but I do, given the
glacier pace of response on other things, and also the fact
that you when testify before Energy and Commerce, they are
still waiting for numbers from you, do we need to go ahead and
subpoena this information now?
Ms. Tavenner. I believe I've gotten you information as
you've requested it.
Mr. Collins. You never--I've never requested information
from you, Ms. Tavenner. I'm looking at your history.
Ms. Tavenner. This committee.
Mr. Collins. So let me ask the question point blank. Will
you get it in a timely manner, not glacial pace, not biblical;
within the next few days?
Ms. Tavenner. I will get you the information as soon as I
can.
Mr. Collins. Do I need to subpoena them?
Ms. Tavenner. You have not needed to subpoena me in the
past.
Mr. Collins. We just have to wait forever.
When were these contracts negotiated?
Ms. Tavenner. These contracts were negotiated over the
summer. I have to get you the specific dates.
Mr. Collins. Okay. Please include that in your information.
Did every insurer participating in the 2015 ACA exchanges
receive such a clause in their contract?
Ms. Tavenner. I believe the contracts were consistent, but
I'll get you that information.
Mr. Collins. Okay. Will you provide a copy of all these
contracts?
Ms. Tavenner. I will work with you. I will have to talk
with our counsel. But unless there's a reason not to, yes, we
will get you contracts.
Mr. Collins. And without being editorialize here, why would
there not be a reason to provide these contracts?
Ms. Tavenner. I don't know that there is. I said I would
work with you.
Mr. Collins. Okay. Again, we're having--is it--maybe it's a
disconnect between here and there. And, honestly, I'm not
trying to be argumentative at this point.
But you actually do work for the government. You do work
for an agency that is under jurisdiction of this committee,
under this oversight provision of transparency and everything
else.
Why would you even have to hesitate on providing contracts
that are public moneys were spent on to this committee?
Ms. Tavenner. I don't think I would. I just ask that I
would be able to ask that question.
Mr. Collins. To who? You run the department.
Ms. Tavenner. Counsel. I'm not an attorney.
Mr. Collins. Well, that's not a bad or good thing. My
question is, you run the department.
Ms. Tavenner. I run CMS, yes.
Mr. Collins. How many attorneys do you have working for you
besides the ones that came with you?
Ms. Tavenner. I don't have any attorneys here with me.
Mr. Collins. Okay. Maybe there's our problem.
All right. But, again, I'm not sure why we can't answer
that question.
Let me reverse back. We know when we've determined that you
do get briefings on insurers asking for Federal Government to
pay for them under cost-sharing reduction. CMS asked insurers
to submit on a monthly basis pre-populated Excel spreadsheets
that contain this information. Correct?
Ms. Tavenner. That is correct.
Mr. Collins. Thank you. The amount the insurers asked the
Federal Government to pay them under cost-sharing reductions is
an individual line item on the spreadsheets. Is that correct?
Ms. Tavenner. I believe that is correct.
Mr. Collins. Thank you. Wait. I had one question here.
There is an issue here--and I want to go back to a
question. It says who made--I want to know who made the
decision not to request appropriations for cost-sharing
reductions program for fiscal year 2015.
Ms. Tavenner. That is not within my purview. I can't answer
that question.
Mr. Collins. Do you not have to adjust and spend the money
out of--that was supposedly appropriated for this program?
Ms. Tavenner. I do not--that is done through our financial
department. I'll be happy to get you that----
Mr. Collins. Can you provide any--so would your financial
department have participated in a decision not to ask for
appropriations in 2015?
Ms. Tavenner. I don't have that. I'll be glad to get you
that information.
Mr. Collins. Okay. So, again, you--under your leadership,
this is a department that is basically going rogue and doing
their contracts that don't report back to you or budget items.
Ms. Tavenner. I will be happy to get you that information.
Mr. Collins. That must hard to say every time. When I know
you--you understand this. It must be that difficult.
Who did participate, and will you provide those names?
Ms. Tavenner. I have told you I will get you that
information.
Mr. Collins. Is there anyone outside that we need to ask?
Was this OMB? Treasury? White House? Anyone else who would have
determined not to ask for appropriations for this program in
fiscal year 2015?
Ms. Tavenner. Once again, I will go back and try to get you
the information----
Mr. Collins. So you have no idea when these meetings even
took place. Would that be a fair statement?
Ms. Tavenner. I cannot answer your question. I will try to
get you that information.
Chairman Issa. Gentleman's time has expired.
We now go to the gentlelady from Wyoming, Mrs. Lummis.
Mrs. Lummis. Thank you, Mr. Chairman. And thank you for
your leadership these past couple of years. Appreciate your
hard work on this committee.
Dr. Gruber, did you participate in the scoring aspect of
the Affordable Care Act?
Mr. Gruber. I provided economic microsimulation results to
the administration and Congress to help understand the costs
and coverage effects of the law, but I did not provide any
official scoring.
Mrs. Lummis. You have stated that the ACA was written in a
way, a tortured way, so CBO would not score it as a tax.
Now, how did the administration use your information to
write the ACA in a tortured way so CBO would not score it as a
tax?
Mr. Gruber. Once again, I apologize for my inopportune,
just inappropriate terminology. But I----
Mrs. Lummis. Well, but they didn't score it as a tax.
Right?
Mr. Gruber. The administration--I did not draft
legislation----
Mrs. Lummis. How did you do it? How did you get CBO to not
score it as a tax, knowing that at some point you might have to
get the U.S. Supreme Court to say it was a tax? How did you do
it?
Mr. Gruber. I don't run CBO. I didn't draft the
legislation.
Mrs. Lummis. What does CBO stand for?
Mr. Gruber. Congressional Budget Office.
Mrs. Lummis. And what is scoring?
Mr. Gruber. It's the method by which the Congressional
Budget Office estimates the effects of legislation on things
like the Federal budget.
Mrs. Lummis. You have said, in 2012 remarks at Noblis, that
you wrote part of Obamacare yourself. What parts did you write
yourself?
Mr. Gruber. If I said that, that was, once again, an effort
to seem more important than I was. I drafted----
Mrs. Lummis. Why would you say you wrote part of Obamacare
yourself, and you're the numbers guy. They used your modeling.
And they knew they might have to convince the U.S. Supreme
Court that it was a tax and convince the Congressional Budget
Office, for scoring purposes, that it was not a tax. How did
you do that?
Mr. Gruber. Ma'am, once again, I did not write any part of
the Affordable Care Act.
Mrs. Lummis. Why did you say in 2012 explicitly that you
wrote part of Obamacare yourself?
Mr. Gruber. I was speaking glibly----
Mrs. Lummis. How many nonpoliticians know what CBO is? How
many nonpoliticians know what scoring is? How many
nonpoliticians would know that you have to get by CBO scoring
in order to get the Affordable Care Act to say that it's going
to lower costs?
You are a politician. Everything that has led up to your
testimony today is inconsistent with your testimony today,
which is to say all of your prior statements were a lie. Is
that true? Were all of your prior statements a lie? Or were
they just glib?
Mr. Gruber. They were not a lie.
Mrs. Lummis. I want to change subjects and visit with Ms.
Tavenner about something that you began to discuss with Dr.
Gosar. And that is, is there a decline in participation? Is
that what has yielded smaller increases in the costs of
healthcare?
Ms. Tavenner. I don't have an answer to that. And I think
we'd have to wait for someone. It's too early to know.
Mrs. Lummis. Is there a way to analyze the information to
get that fact, to determine it?
Ms. Tavenner. I think if you look at the Medicare Trustee's
report, I think if you look National Health Expenditure, it
will show you trends.
Mrs. Lummis. Okay. I'm hopeful to get those trends.
I'm going to give you a little story. I'm on Obamacare. My
husband was on Obamacare with me. And we were told that we were
enrolled in Obamacare. And then when we filed claims, we were
told we were not enrolled in Obamacare. And then we got it
straightened out, and he filed claims and we were told once
again that we were not on Obamacare.
Well, come to find out my husband was having chest pains at
the time that he was told we were not enrolled in Obamacare.
And come to find out he didn't have all of the tests that he
was advised by his physician to have.
So, on October 24th, a week before election, my husband
went to sleep and never woke up. He had a massive heart attack
in his sleep at age 65, -a perfectly by all appearances healthy
plan.
Come to find out in a conversation with his physician after
he died, he chose not to have one of the tests, the last test
his doctor told him to have. This happened to coincide with the
time that we were told that we were not covered by Obamacare.
I'm not telling you that my husband died because of
Obamacare. He died because he had a massive heart attack in his
sleep. But I am telling you that during the course of time that
he was having tests by a physician and was told we were not
covered by Obamacare, that he then decided not to have the last
test the doctor asked him to have.
Let me suggest that there may be a decline in participation
and that it may not be to the benefit of the American people.
I want to suggest that, regardless of what happened to me
personally, that there have been so many glitches in the
passage and implementation of Obamacare that have real-life
consequences on people's lives. And the so-called glibness that
has been referenced today have direct consequences for real
American people.
So get over your damn glibness.
I yield back.
Ms. Tavenner. First of all, I'm sorry.
Chairman Issa. I thank the gentlelady.
Ms. Tavenner. Could I answer?
Chairman Issa. I don't think she had a question for you.
Mrs. Lummis, Do you have a pending question?
Mrs. Lummis. Mr. Chairman, I really do yield back.
Chairman Issa. The gentlelady yields back.
We go to Dr. DesJarlais of Tennessee.
Mr. DesJarlais. Thank you, Mr. Chairman.
Mr. Gruber, I wanted to talk to you a little bit in my time
here today about your understanding of the State and Federal
exchange premium assistance as we've talked about that today,
and you've referenced it several times.
But let me first just make sure I understood what you told
Mrs. Lummis a second ago about all your comments. I know you've
been here today. You've been very humble. You've been eating
crow. You don't like the way you said things. You've been
walking those back. But she asked if all those all those
statements were a lie, and you just said they were not lies. Is
that what you said?
Mr. Gruber. They were glib and thoughtless and really
inexcusable.
Mr. DesJarlais. But, in terms of content, you weren't
lying. You don't like the way you said it, but what you said
you had some basis for.
Mr. Gruber. The comments that I made were just my
conjecturing outside my area of expertise.
Mr. DesJarlais. Well, Mr. Gowdy talked about that. And you
did that an awful lot. I don't think you were necessarily out
of your area of expertise. In fact, I think you nailed most of
what you said. Just politically maybe you weren't being a good
politician, you weren't good in the way you said them.
But I, just for one, applaud you for coming forth with
those statements and telling people that, you know, this was a
difficult law to pass, wasn't it? When you were up here
advising people, trying to get the healthcare law passed. It
was a difficult sell, wasn't it?
Mr. Gruber. It was a very challenging political fight.
Mr. DesJarlais. One, because the American people were very
afraid of a government takeover of healthcare. They didn't want
socialized medicine.
But, now, some people did want that, they wanted a single-
payer system, didn't they?
Mr. Gruber. I believe some Americans do support a single-
payer system.
Mr. DesJarlais. Okay. But, optically, that was tough for a
lot of people up here to sell to the American people. Because
people are opposed to the healthcare law, and that's why there
were not a single Republican can vote; in fact, they really had
to wrangle a lot Democrats to get their vote. There was all
kinds of deals that basically put a lot of Democrats out of
office.
But, I mean, that's beside the point.
What I want to get to was your understanding of the State
and Federal exchanges. Because when they started talking
Federal exchanges, that sounded to the people a lot like a
Federal takeover of healthcare. So State-run exchanges were a
lot more palatable. It was a lot better optically. So that's
what was pushed. In fact, that's what was written in the law,
wasn't it? That the States would set up exchanges and they
would offer premium subsidies.
Mr. Gruber. I don't have the exact wording of the law in
front of me. But I believe the law said, as was referenced
earlier, that the State should set up exchanges and, if not,
there would be a Federal backstop.
Mr. DesJarlais. Okay. So you know--realize, then, that a
Federal backstop was always in play. I mean, the States had the
option. But, if not, the Feds had to set up an exchange.
Mr. Gruber. That's the way the law was written.
Mr. DesJarlais. Okay. So your comment on January 12 of
2012, you said, if you're a State and you don't set up an
exchange, that means your citizens don't get their tax credits.
Mr. Gruber. Once again, that was my trying to be glib and
trying to summarize a subtle point----
Mr. DesJarlais. Were you being glib? I mean, you were
concerned about the Federal exchanges. Why?
Mr. Gruber. I was concerned about the Federal exchanges
because it was a very complicated task to get them set up, and
we weren't sure who would be President when the time came to
stand them up.
Mr. DesJarlais. Okay. So who was going to be President. So
it was political. It was a tough sell, once again. People
didn't want it, but there was a lot of smoke and mirrors, and
there was a lack of transparency. And you said that in one of
your glib statements, even though it was very accurate.
But, in your opening statement today, you said that the
point you were trying to make about the possibility of Federal
Government was whatever reason they might not set up a Federal
exchange.
Well, you just said that they had to set up a Federal
exchange. You just testified to that. Right?
Mr. Gruber. The law said that there should be Federal
backstop.
Mr. DesJarlais. Okay. But it didn't say that the Federal
exchange would subsidize people in those States. And that's why
you made the comment in 2012; correct?
Mr. Gruber. It is a very clear reading of the law that tax
credits should be available to citizens in all States
regardless of who runs the exchange.
Mr. DesJarlais. It's not clear. That's why there's a
Supreme Court case. It's not clear at all. That's why we're
going to hear this.
But you knew in January of 2012 that there was a concern.
The President knew there was a concern because he assumed the
States were going to set up exchanges. He put enough incentives
in there, he thought they would fall in line, and they would
have that nice optic of not having a Federal takeover of
healthcare but, rather, State-run exchanges. Well, only 16 did.
And then there was a problem. So that's why you were concerned
in 2012. Correct?
Mr. Gruber. My comments in 2012, as I said, were my effort
to try to seem like I knew more than I did.
Mr. DesJarlais. You belittle yourself. You know a lot. You
were the guy they turned to to do this. I mean, you were the
one that they were going to to get advice. You ran the models.
You had all these models for State and Federal exchanges. Did
you not have a model in the event that this happened, what's
happening now, 16 States and the rest are Federal, was there
not a model that showed financially that was unworkable?
Mr. Gruber. I am an expert within economics and
microsimulation modeling. In the microsimulation modeling, I
did, I assumed tax credits would be available in all States.
Mr. DesJarlais. And so you knew that, but they didn't write
in that the law. But who did? It wasn't Congress. Four months
after you made your comment in 2012, apparently the IRS listens
to you because they did an end around Congress and they rewrote
and promulgated a rule to say that Federal exchanges also had
to offer subsidies. And that's why you were concerned in
January. IRS listened to you. They came through, took an eraser
to the bill, and tried to change it for Congress because they
knew we wouldn't change it for them.
Mr. Gruber. Is there a question?
Mr. DesJarlais. Well you can comment on that. Am I wrong?
Mr. Gruber. I can't conjecture on what the--why the IRS did
what it did----
Mr. DesJarlais. You conjectured in 2012, you conjectured in
your opening statement that you always assume that. But you ran
models, and apparently the legislators didn't listen to those
models because, in a hurry, they passed this bill to try to
sell it to the people of the State-run exchanges. But they
didn't have language saying the Federal exchanges would
subsidize the taxpayer--subsidize the people.
Mr. Gruber. As I said, I think a clear reading of the law
makes it clear the tax subsidy should be available to citizens
in all States, regardless----
Mr. DesJarlais. Again, that's why we're in the Supreme
Court. That's why it's going to the Supreme Court, because it
wasn't clear.
Ms. Tavenner, real quickly, if I may.
Do you know, you're the numbers person, you said there were
6.7 million people that signed up for the Obamacare. Is that
right?
Ms. Tavenner. 6.7 million people as of October 15th had
paid their premiums.
Mr. DesJarlais. I don't know, I'm hoping you know this, and
you may or may not have it with you, may have to get to it me,
but if you do, please tell me. How many of these people who
signed up are Federal workers?
Ms. Tavenner. Are Federal workers?
Mr. DesJarlais. Yes. People who are already on Federal
health care, and then they switched over to Obamacare like Mrs.
Lummis just did.
Ms. Tavenner. I don't know that number. But I would assume
the only individuals would be the Members of Congress who were,
like her husband, in the exchanges----
Mr. DesJarlais. Well, there's that and there's Federal
employees all over this country. Two to 4 million Federal
employees. How many of those signed up for Obamacare?
Ms. Tavenner. I don't know. I'd be glad to try to find that
out.
Mr. DesJarlais. I'd like to know that because I'm just
wondering, out of the 6.7, how many actually helped the private
citizens of this country and how many of those are actually
just Federal workers that shifted over to the healthcare
exchanges.
Ms. Tavenner. I mean, that numbers--those numbers may be
available in the D.C. exchange. I'll see if I can get you that.
Mr. DesJarlais. Thank you, Ms. Tavenner. Thanks to all the
witnesses.
Chairman Issa. Thank the gentleman.
We now go to the gentleman from South Carolina, Mr. Rice.
Mr. Rice. Thank you, Mr. Chairman. And thank you for
allowing me to speak in as a guest today. This has been a truly
fascinating hearing.
Professor Gruber, when you spoke in your videos, which I've
watched with great interest, you said that the administration
used a lack of transparency to its advantage in getting these--
the Affordable Care Act passed. But I think you spoke with a
great understatement. It's more and more clear the more we
speak here today that it's actually the Affordable Care Act was
passed as a pack of lies on a foundation of deception. And it
continues here today.
Going back to what Dr. DesJarlais was just asking about,
your assessment in 2012 that if a State didn't set up an
exchange, that its citizens would pay the tax and benefit the
citizens in other States. And now you say that's incorrect?
Mr. Gruber. What I said in--as I said, what I said in
January 2012 was that if a Federal exchange was not established
and only in that circumstance, then States that did not have--
--
Mr. Rice. You didn't say that in January of 2012. You're
saying that today. What you said in January of 2012 was that if
the States, recognizing their citizens would pay the tax but
not get the benefit, that that would be a sufficient economic
incentive for them to set up the--set up the exchange. That's
what you said in 2012.
You didn't say anything about a Federal exchange.
Mr. Gruber. As I've said, I was conjecturing areas beyond
my expertise, trying to seem smarter than I was. And I just
shouldn't have done that.
Mr. Rice. When you say ``conjecture,'' you mean lies? Is
that what you mean?
Mr. Gruber. No, I mean conjecture.
Mr. Rice. So you were telling the truth back then in 2012.
Ms. Tavenner. I was conjecturing.
Mr. Rice. All right. You also said in 2012 that the taxes
under the Affordable Care Act were put on the insurance
companies and not on individuals, knowing full well that the
insurance companies would pass them on down to individuals as
an additional premium, and that was disguised tax. Do you still
believe that?
Mr. Gruber. I do believe, as many economists do, that in a
competitive insurance market, if you levy a tax on an insurer,
it will be largely passed forward to premiums to their
consumers.
Mr. Rice. Okay. It was a way of hiding the tax on the
individual. That's the way you described it in 2012. Do you
still believe that?
Mr. Gruber. Once again, that was me conjecturing about
political areas that I shouldn't have. What I believe is the
economics that I just stated to you.
Mr. Rice. You also said that if the people had known, if
the taxpayers, the stupid American taxpayers, had recognized
that we were shifting costs from healthy people to unhealthy
people, you said that the law wouldn't have passed. Do you
still believe that?
Mr. Gruber. That was once again my trying to pretend I'm
something I'm not, which is a political expert.
Mr. Rice. Okay. So are you saying that was a lie then or is
it a lie today?
Mr. Gruber. It was a conjecture and my trying to be
something I'm not.
Mr. Rice. All right. You said that the Affordable Care Act
was written in a tortured way to avoid the mandates being
scored by CBO as a tax. Because you knew if it was scored as a
tax, it wouldn't pass. You still believe that today?
Mr. Gruber. Once again, that was my trying to act like I
was a political expert that I'm not.
Mr. Rice. So what you're saying, then, is you were lying
then?
Mr. Gruber. What I'm saying is I was conjecturing in an
area which I shouldn't have.
Mr. Rice. You weren't lying, then. Okay. So you still
believe that, I suppose.
All right. Do you believe--do you still believe that this
deception was necessary to get the law passed?
Mr. Gruber. The statements to which we've been referring
today were, once again, conjectures by me in an area in which
I'm not expert.
Mr. Rice. You served as an adviser to CBO from 2008 until
when?
Mr. Gruber. I joined--I don't recall exactly. I believe
someone said I joined the council of--the advisory council CBO
in 2007. And I went to a few meetings. And those meetings
ended--the last meeting was maybe end of 2008 or very early
2009.
Mr. Rice. So, at that time, this law was being drafted
wasn't it?
Mr. Gruber. No.
Mr. Rice. Okay. You're not sure about the--you're not sure
about when you got off of this CBO advisory panel.
Mr. Gruber. I'm not sure either about when I got off or the
last meeting I was at.
Mr. Rice. That would seem to me to be, somebody who is as
detail oriented as you testified you are, that's pretty
important. Because CBO is supposed to be a nonpartisan,
independent advisory group. And if you're being paid by the
administration to advise them on tortured language to avoid
these things being scored as a tax, isn't that kind of a
conflict of interest?
Mr. Gruber. I am certain--actually, I am pretty sure that I
did not attend any meetings of a CBO----
Mr. Rice. I don't care if you attended meetings or not.
Were you on the panel or weren't you?
Mr. Gruber. I don't know the official date at which they
took me off the panel.
Mr. Rice. Not very detail oriented for somebody who is
supposed to be detail oriented.
Do you believe the administration used lack of transparency
to its advantage in passing the Affordable Care Act as you said
in 2012?
Mr. Gruber. What I said in 2012 was just trying to speak
about an area in which I'm not expert.
Mr. Rice. Okay. So let me ask you this. Forget about 2012.
Do you believe today the administration used a lack of
transparency to its advantage in passing the Affordable Care
Act?
Mr. Gruber. I believe the Affordable Care Act was debated
extensively and was a very transparent process.
Mr. Rice. So you were lying in 2012.
Mr. Gruber. In 2012, I was conjecturing about political
things----
Mr. Rice. What you said just now is in direct opposition to
exactly what you said in 2012. So it was a lie today, or it was
a lie in 2012. Which one's a lie?
Mr. Gruber. I believe that the Affordable Care Act was
passed in transparent?
Mr. Rice. So you were lying in 2012 is what you're saying.
Mr. Gruber. 2012, I was trying to play amateur politician,
and I shouldn't have done that.
Chairman Issa. I thank the gentleman.
I gather the gentleman's really saying amateur politician
in which, as a politician, you're allowed to say things that
just aren't true out on the stump. And then when you're under
oath. You say the truth, right?
Mr. Rice. Yes, sir.
Chairman Issa. I gather.
I thank the gentleman for your participation.
Mr. Rice. Thank you very much.
Chairman Issa. I'm going to try to get this done so we can
recess. We have a vote on the floor.
But, Ms. Tavenner, can we get the cost-sharing reduction
payment figures requested by Mr. Collins in the next 10 days?
This is fiscal year 2014 plus 2015 payments to insurers. Could
we be assured we'll have it in the text 10 days?
Ms. Tavenner. So it has the 2014 payments.
Chairman Issa. Right. Fiscal year 2014.
Ms. Tavenner. Yes.
Chairman Issa. Can we get copies of the revised insurer
contracts, which include the opt-out clause within the next 10
days?
Ms. Tavenner. Yes.
Chairman Issa. Thank you. Can any--has any insurer
participating in the 2015 Affordable Care Act exchanges
expressed any concern at any time to anyone that to your
knowledge in is executive branch of the Federal Government
regarding the lack of an appropriation of funds to make cost-
sharing reduction payments to insurers?
Ms. Tavenner. Not to me. I'm not aware of anyone else. But
definitely not to me.
Chairman Issa. But you know of no question from any
insurers you haven't heard through staff.
Ms. Tavenner. About cost-sharing reduction, no.
Chairman Issa. Okay.
Chairman Issa. Mr. Gruber, I'll be quick. You are familiar
with the CBO, you sat on the advisory board, and you made this
comment about tortured scoring. I know the tortured scoring, so
let's go through it very quickly.
Isn't it true that the Affordable Care Act received revenue
in years in which it was paying nothing out, which allowed, in
the 10-year window, for it to have revenue that on a long-term
basis could--would not fail to have a deficit? In other words,
by collecting a tax before they began paying out, that shifting
in the 10-year window, causes the 10-year window to show a
balance that disappeared later, but a balance that in the next
10-year window would not exist? Isn't that true?
Mr. Gruber. The Affordable Care Act did have revenue-
raising provisions which started before 2014, but it lowered
the deficit overall in the first decade, and by increasing----
Chairman Issa. We're not worried about the deficit, but
it--that's the tortured stuff you were talking about, is that
because they were able to not score certain things as
expenditures, make certain assumptions in there and, most
importantly, collect revenue which was during a period in which
they were paying nothing out, that gave them a score of revenue
that, in fact, on an ongoing basis--in other words, if they
started on the day that the Affordable Care Act began providing
services and took only the revenue during that period, they
would have had a deficit. Isn't that true?
Mr. Gruber. If they started the day the Affordable Care Act
began and they went for the next decade, they would have showed
a massive surplus.
Chairman Issa. You're saying that, in fact--are you sure
you want to say that as your knowledge, that, in fact, today,
for example, with the payout and the--the in, you want to say
that the incremental Medicaid payments and so on that were
caused as a result of the Affordable Care Act would, in fact,
have had a surplus, not a deficit, in revenue?
Mr. Gruber. My recollection of the numbers--and I haven't
looked at them in a while--my recollection of the numbers was
that by the end of the decade, that on a year-to-year basis,
the Affordable Care Act significantly lowered the deficit such
that if you add up to 10 years after 2014, I believe that if
you go by CBO's numbers, that that would have been deficit
reducing.
Chairman Issa. You are aware that CBO has revised their
numbers and they now show a deficit in the Affordable Care Act
and have since really shortly after the parties changed here in
the House and they redid their numbers.
Ms. Tavenner, you aware that they show a deficit--that CBO
has revised their numbers, they no longer stand behind the
numbers during passage?
Ms. Tavenner. I'm not aware.
Chairman Issa. I sure wish you had been aware of it.
Mr. Cummings.
Mr. Cummings. You had not heard that? I hadn't heard it
either.
Ms. Tavenner. I don't think so.
Mr. Cummings. But we'll check on that.
I just--as I close, let me just say this, you know, one of
the things that I--that I think about and talk about the older
I get is that we have a limited amount of time to be in these
offices. And I'm so sorry, Mr. Gruber, that you said what you
said, you can call it conjecture, whatever, and I'm so sorry
that the mistake was made, and I do believe it was a mistake,
but what it does is distracts, it distracts from all of the
good things that are being done with regard to this law, and
that--and that is the most painful part of all this, you know.
You know, I talked to a lady the other day who had to wait for
the Affordable Care Act to go into effect to get breast cancer
treatment. I mean, I can just--story after story after story,
and now we've got to spend all this time dealing with
something, Mr. Gruber, that you--you know, you were
conjecturing about.
I just told my staff, I said we ought to learn from this.
You've got to watch what you say, you know, watch what you say,
because it can lead to significant consequences.
And I was so sorry to hear about Ms. Lummis' husband, and I
know you wanted to say something. I was just curious, what did
you want to say, Ms. Tavenner?
Ms. Tavenner. Just, first of all, I wanted to express my
sorrow at her loss, and that we would follow up with the D.C.
exchange to see what had happened.
Mr. Cummings. Yeah.
Ms. Tavenner. I know that's cold comfort now, but----
Mr. Cummings. Yeah. That's a painful story.
Ms. Tavenner. Yes.
Mr. Cummings. But--and--and so anyway, I--again, Ms.
Tavenner, I hope you'll go out there and you'll continue to
work hard to make this work. No matter what happens in these
hearings, we've got to protect people's health, we've got to
try to keep people well and help families stay strong, because
I think that when we have an unhealthy population, we have an
unhealthy country.
And, Mr. Gruber, you know, you call it amateur politics or
whatever you want to call it, like I said, I think the most
painful thing--and I always try to keep sight of the big
picture. You know, my mother has a saying, she says, small--big
can't get you if small's got you. And I think sometimes we can
get so caught up in distracting things, that we don't deal with
the bigger picture, the life and death situations, and so--but
thank you all much for your testimony.
Chairman Issa. I'm going to close the hearing.
Mr. Goldman, thank you for your participation.
Mr. Goldman. Thank you.
Chairman Issa. Yeah. Thank you for your participation. I
suspect that this is an unusual event for you, and you carried
yourself off well, even though there weren't as many questions.
Perhaps if you'll post a few videos, you will get an
opportunity.
Mr. Gruber, I think you saw here that, on both sides of the
aisle, at least a number of members don't buy that you were
saying one thing there that you didn't believe. I think most of
us believe you believed a lot of what you said. And in the case
of the tortured accounting that CBO used with 10 years worth of
revenue and a fraction, only about 6 years worth of payout, it
was tortured. It is tortured. And the American people in the
long-run are going to realize there's no free lunch, and paying
100 percent and then later 90 percent of Medicaid payments as
the major part of the new insured under Obamacare has a cost,
it has a cost to the taxpayers, and the taxpayers are who we
represent from this side of the dais.
Ms. Tavenner, the only reason you're back here today is
that you came with figures that are deceptive, needlessly
deceptive. We can take bad news here. We've overseen a lot of
agencies, problems at the Department of Transportation,
problems at the Secret Service and others, and Mr. Cummings and
I have been able to work without endlessly bringing people back
when there's open and transparent delivering of information.
Now, you've made some specific promises of delivering
information today. I trust that you will keep those. I will
tell you that no matter who sits in this chair, and I've sat
here under five chairmen--or four chairmen, and I can tell you,
Mr. Waxman would have been just as animated as we are here
today, that, give us the bad news, give us what you have, even
give us bad information. In the early days of the stimulus
package, we were told there were congressional districts in
numbers greater than existed, and we laughed a little bit and
we had hearings. But, at the end of the day, working with Earl
Devaney and other people, we accepted that they were giving us
the best information, and when we saw mistakes, they corrected
them. You have that opportunity. I won't be in this dais, you
know, next Congress, but somebody else will, and when they call
you back, tell us what you don't know early on, not when we ask
for facts later on, and that will be helpful.
I've said all along that the problem in this administration
is that they didn't live up to their promise of being the most
transparent administration in history. The standard, the bar
was low. All administrations have a tendency to deliver good
news in press conferences and bad news at the latest possible
date.
So I want to thank my ranking member. He said earlier that
he--that I made him better. Well, I will tell you, Mr. Cummings
has worked very hard to make me have to be better in trying to
get to the truth, and I've learned a great deal.
And I will just say one thing in closing to my friend. I
would do things differently with what I now know, but I would
hope that anyone who sits in this chair would never do less
than I have done, because it is our watch, it is our time, and
I think you and I have worked hard to try to make sure this
committee did as much as it could, and my only regret is that
we couldn't do more. So I want to thank you.
Mr. Cummings. Thank you, Mr. Chairman.
Chairman Issa. Thank you.
We stand adjourned.
[Whereupon, at 1:38 p.m., the committee was adjourned.]
APPENDIX
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