Wednesday, September 26, 2018
Politics

PolitiFact Florida: Rick Scott misrepresents the bipartisan origins of Obamacare

Donald Trump's White House win gave Florida Gov. Rick Scott a powerful ally in his fight against Obamacare.

The former hospital executive reiterated his 2010 campaign pledge to fight for repeal of the federal health care law in a recent USA Today op-ed.

"Other than President Obama and a few stragglers, everyone now realizes that Obamacare was a terrible notion," Scott wrote. "It was sold on a lie. It was invented by liberal academic theorists who have no interaction with real families and businesses, and therefore it doesn't work."

Scott's piece misleads readers about the origins of the Affordable Care Act of 2010. It is based on ideas from not just Democrats, but also Republicans.

"Scott's comment is so sweeping that it's hard for it to be anything other than an exaggeration," said Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush.

The "liberal academic theorists" in question, Scott's spokeswoman said, are MIT economist Jonathan Gruber, Harvard economist David Cutler and Ezekiel Emanuel, who is now chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

We interviewed all three about their role in the health care law and with President Barack Obama.

Gruber developed the economic model for the law, earning him the most media attention of the three. He was instrumental in helping Massachusetts create its law, and the federal government contracted with Gruber to provide technical assistance.

The national law was patterned after the Massachusetts version. Both require everyone to have health insurance or pay a penalty, leave the current insurance system in place, and expand coverage for the uninsured through subsidies or Medicaid.

Media reports often refer to Gruber as the "architect" of the Affordable Care Act, but others who worked on the legislation dispute that characterization. Gruber's involvement with his economic model was important, but he didn't determine what policies made the cut, said John McDonough, a Harvard health policy professor who was a senior adviser to the Senate Health and Education Committee when the law was written.

As for Cutler, he appears to have had the least to do with the law. Scott's spokeswoman pointed to an October article in Politico referring to him as a "key architect" of Obamacare. But most articles we found described him as a health care adviser on Obama's 2008 campaign and an advocate of the law.

Cutler told us that he did speak with members of the Obama administration, Congress and interest groups, but "I did not serve in the administration and never wrote a line of the ACA."

Emanuel was more involved in the law as a paid special adviser for health policy to the director of the federal Office of Management and Budget from 2009 to 2011.

Emanuel now works at the University of Pennsylvania, but he wasn't working in academia while he worked for OMB. (His brother Rahm was Obama's former chief of staff.)

Emanuel worked on a lot of the details of the bill, he said, including subsidy levels.

Bipartisan roots

The fact that two of the three experts Scott had in mind have ties to the law does not change the inaccuracy of his point.

The backbone of Obamacare started forming amid earlier attempts to overhaul the health system, including by Bill and Hillary Clinton.

Their proposal for universal health care prompted Republicans to come up with an alternative in 1993. While as a party Republican senators never reached consensus, Republican Sen. John Chafee of Rhode Island introduced a bill with 18 Republican co-sponsors (although some later withdrew) and two Democrats as co-sponsors.

Chafee's bill had similarities to Obamacare. It included an individual mandate, created purchasing pools, standardized benefits, vouchers for the poor and a ban on denying coverage due to pre-existing conditions.

Another key player was the conservative Heritage Foundation, which advocated for health insurance exchanges including when Massachusetts, led by a Democratic Legislature and Republican Gov. Mitt Romney, crafted its own law in 2006.

Jonathan Oberlander, a health care policy specialist at the University of North Carolina at Chapel Hill, said some, but definitely not all, of the federal health law's creators were liberal academics.

"There were many cooks in this kitchen and these ideas were generated over a long period over time," he said. "In many respects the ACA's design and some of its major policies embodied what used to be core tenets of GOP philosophy on health care."

Scott's statement contains an element of truth but ignores critical facts that would give a different impression. We rate the claim Mostly False.

Edited for print. Read the full version at PolitiFact.com/florida.

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