Earlier this year, The New York Times called Jonathan Gruber “Mr. Mandate.” And with good reason: His in-depth modeling of health-insurance markets helped create the legislation for mandatory private insurance that is near the center of the U.S. presidential election.
Indeed, Gruber is in the unique position of having made a vital policy contribution to each major-party candidate. Gruber’s work helped convince Mitt Romney, then governor of Massachusetts, to sign a 2006 bill mandating insurance, with subsidies if needed, for all state residents. And when President Barack Obama took office in 2009, the White House enlisted Gruber as a key numbers-cruncher on health care; his analysis ultimately established the fiscal viability of the Affordable Care Act (ACA).
Gruber, a professor of economics at MIT, cares intensely about health care as a social issue. But once upon a time — the 1980s, to be precise — Mr. Mandate had no interest in the subject. As an undergraduate at MIT, “I didn’t know I was going to do economics,” Gruber says. Instead, he says, he was a “money-uber-alles” — money over everything — person, detached from civic issues.
A few things changed that, such as an MIT political scientist who urged Gruber to become socially active, and his own research as a young MIT professor, which illuminated the huge advantages of access to health care.
“I decided that giving people health insurance was something that really mattered,” Gruber says. MIT’s motto may be mens et manus (mind and hand), but Gruber’s career arc has also been shaped by mentors and math — in the sense of taking hard numbers about health care seriously.
Bitten by the policy bug
Gruber, 47, grew up in New Jersey. As an MIT undergraduate, he says, he never really expected to become a physical scientist or engineer.
“I have humanistic tastes, but math skills, so economics was a great landing point,” Gruber says. Among other faculty, he studied with international economist Rudiger Dornbusch (his adviser), economic historian Peter Temin, and James Poterba, an expert in taxation and household finance.
Gruber’s interest in politics lay dormant until he took a class with the late Louis Menand III, a longtime MIT administrator and lecturer in political science.
“Louis Menand’s course … really opened my eyes to thinking about the broader social issues,” Gruber says. Menand made two suggestions that Gruber followed: Get involved in student politics, and get a taste of Washington. Gruber served as a student representative on a committee helping to reshape MIT’s undergraduate curriculum, and got an internship at the Brookings Institution in Washington, where he was “bitten by the liberal policy-advocacy bug.”
“I think I had it in me,” Gruber says, “and Menand said, ‘Look, here’s the way you can use your intellectual skills in the world to do good,’ and it really appealed to me.”
Still, Gruber nearly attended law school, only choosing graduate economics “at the very last minute.” Gruber enrolled in Harvard’s PhD program, intending to study international economics, but switched to health care partly because his graduate advisor — Lawrence Summers, the future U.S. Treasury Secretary — suggested there were many health-care problems worth tackling in economics.
Summers also published a theoretical article in 1990 about “adverse selection” — in which, say, people with costly health problems form a disproportionate share of an insurer’s clients, driving prices up for everyone — that helped steer Gruber toward the topic of mandates. “Larry really laid out clearly how to think about them in a very simple way, and it was a great taking-off point for me,” Gruber explains.
Gruber’s 1992 PhD thesis, which became his first high-profile published article, showed what happened when some states mandated maternity benefits for female employees: “As a result they get paid less,” Gruber says. Another Gruber study demonstrated that state mandates adding coverage for certain types of illnesses didn’t deter firms from offering employees insurance. Still another mid-1990s study showed how deeply “Medicaid really mattered for people’s health,” he says.
A model economist?
By the late 1990s, Gruber had been awarded tenure at MIT and unearthed some rich data about health-care reforms, but was still outside the policy wars. Then Summers asked Gruber to serve as a deputy assistant secretary for economic policy in the Treasury Department, in 1997 and 1998. There, Gruber was finally persuaded to jump into policymaking, in part by another Clinton adviser.
“He told me, ‘Look, academics are delighted to pontificate on broad theories, but what they don’t do is tell a policymaker, your bill will do X,” Gruber recounts. “‘There’s nobody objective and academic out there saying, ‘If you do X, then Y will happen.’ You should do that.’”
Returning to Cambridge, Gruber added to his empirical research about U.S. health care by modeling what would happen if certain policies took effect. Gruber took an initial assignment on behalf of George W. Bush’s 2000 campaign, as he recalls, followed by work for many states — culminating in enactment of the Massachusetts plan, and then the ACA.
Those plans use what Gruber calls a “three-legged stool” of reforming markets (so that people with pre-existing conditions can get coverage), mandating coverage (which keeps prices low by including the healthy in insurance plans), and offering subsidies to lower-income people. Much of Gruber’s modeling evaluates, in unmatched detail, the nuances of this scheme. But don’t fear the policy details: In 2011 Gruber co-wrote a comic book explaining health-care reform, as part of his larger desire to “translate” economics and policy matters “into English.”
And with the ACA in place — for now, at least — Gruber is returning to empirical research, including a recent paper with Jason Abaluck of Yale University that looks at the problems senior citizens have in choosing among coverage plans involving Medicare Part D, which pays for prescription drugs.
“We found that only 12 percent of seniors made the right choice,” based on their needs, Gruber says. He believes that constructing well-functioning “exchanges” for choosing plans under the ACA will be both a vital policy matter and an important research problem for scholars.
Which means, perhaps, that Gruber can have his health-care policy and study it, too: Having modeled the ACA, he wants to track its real-world effects.
“It’s going to be incredibly exciting to figure out all the things this law is doing,” Gruber says. “There are these feedback loops of policy affecting research, which affects policy, and I think that’s where economics is at its best.”