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This Web Designer Is Leading the Fight Against the Obamacare Repeal

Photo : Elisabeth Gaba

It was December 31, 2013. The Obama administration, after enduring months of bruising media coverage as a result of its botched rollout of the Affordable Care Act’s Heatlhcare.gov exchanges, had finally righted the ship and was enrolling previously uninsured Americans in droves. With the law’s Medicaid expansion and the initial insurance policies set to kick in on January 1, the administration sent surrogates onto cable news shows to push back against Republican claims that the exchanges weren’t attracting new enrollees.

One such surrogate was Phil Schiliro, a White House health policy adviser who appeared on a show hosted by MSNBC’s Kristen Welker. She repeatedly pressed Schiliro on the numbers and whether the exchanges would enroll the 7 million participants projected by the Congressional Budget Office. “I wanted to come this morning and give you some new numbers,” he said. “Unfortunately I can’t do that because we have to verify numbers repeatedly. There is somebody who’s been calculating, there’s actually a group of people. One of them is Charles Gaba.” After Welker briefly interrupted Schiliro, he returned to this thread, saying, “Charles Gaba has estimated there are about 2 million people in the federal and state exchanges. He’s estimated another 4 million people are in the Medicaid program.”

Gaba, who lives in Bloomfield Township, Michigan, 550 miles from where Schiliro sat, had no idea that such a citation was coming. Shortly after Schiliro’s appearance, Gaba received a text from Chris Savage, the owner of a Michigan-focused progressive blog. “He shoots me a message, and he’s like, ‘Dude, I was just watching MSNBC, and they mentioned your name,’” Gaba told me in an interview. Surprised, he went to the MSNBC website and eventually found a clip for the show. Sure enough, his name came up at around the 4:20 mark. “It’s very flattering. It’s very cool, but at the same time, he was saying it as if I was a household name, like I was Nate Silver or something.”

Gaba had a reason to be flummoxed. Just a few months prior, he’d known next to nothing about health insurance policies and held only a surface-level understanding of what was contained in the Affordable Care Act. “I didn’t know a whole lot about it, which is a little embarrassing, because my father was a doctor,” Gaba said. “He ran his own family practice, and my mother was his office manager for a while. I was pre-med myself in college for a few years. Theoretically, I should have followed all this stuff, but I hadn’t followed it that closely.”

But now here he was, being cited by a senior Obama official in front of tens of thousands of viewers. In just a few short months, Gaba had become one of the most authoritative sources on Obamacare enrollment numbers, and over the next few years, his blog, ACASignups.net, would serve as a vital resource for journalists, healthcare workers, politicians, and activists. With Donald Trump now in office and trying to pass his own healthcare bill that would roll back many Obamacare protections, Gaba has been on the front lines of the resistance movement, his numbers and charts cited by thousands of activists, both online and off. All this occurred while he maintained a day job that had absolutely nothing to do with healthcare policy: running a freelance web design business.

Prior to 2013, Gaba had only interacted with health insurance companies insomuch as owning his own business required buying a private plan for his family. Born and raised in Michigan, he went to Michigan State and, after graduating in 1992, spent the next few years as a wannabe film producer, a dream that translated into the much less impressive job of managing several movie theaters. “Around 1999, I started up a website development firm with a college friend,” Gaba said. “Eventually he left, and I bought out his part of the business, and I’ve been sole proprietor for about 17 years now.” For several years, both Gaba and his wife were on her health insurance plan, but she left her job in 2008 and later went on to help him manage his web development business. They were forced to shop in the individual market, eventually settling on a plan offered by Blue Cross.

Though Gaba never considered himself a policy wonk, he was active in politics, participating in his local Democratic Party and blogging regularly over at Daily Kos. Under the pseudonym Brainwrap, Gaba began writing at the progressive blog in early 2004 and, over the years, became enmeshed in the netroots community as it came to power in the mid-aughts. While writing about politics does require at least a passing knowledge of public policy, Gaba freely admits he was no policy wonk. In 2009, when the fight to pass the ACA went down, Gaba had only a rudimentary idea of what the Democrats were proposing. “I knew the basics of it, the Medicaid expansion, and something about exchange websites. I knew there were no annual lifetime limits. But that was really about it. I was paying more attention to the political side of it.”

Gaba’s obsession with the law didn’t kick in until several years later, when, after surviving a Supreme Court case that threatened to dismantle it, Obamacare’s much ballyhooed insurance exchanges debuted to the public. The Obama administration had spent weeks offering rosy predictions about what those exchanges would accomplish. In an interview that would later go on to haunt her, then Health and Human Services Secretary Kathleen Sebelius stated that hitting 7 million signups during the first enrollment period was a “realistic target.” In truth, it was just a number plucked from the CBO’s projections and wouldn’t actually determine the success of the law, but Republicans quickly latched onto it as the benchmark by which to judge whether Obamacare had failed at its objectives.

The shitshow that was the Healthcare.gov rollout is now a matter of well-trodden public record, documented most thoroughly by a Government Office of Accountability report released about a year later. A menagerie of IT contractors, brought together by what many would argue is an outdated and inefficient government procurement process, launched the $400 million Healthcare.gov website on October 1 despite widespread internal agreement that it didn’t work. “Confidential progress reports from the Health and Human Services Department show that senior officials repeatedly expressed doubts that the computer systems for the federal exchange would be ready on time, blaming delayed regulations, a lack of resources and other factors,” the New York Times reported at the time. With the system reportedly unable to handle more than 500 concurrent users at a time, the website was effectively inoperable for the millions who visited during those first few weeks.

When Healthcare.gov debuted, Gaba was at first optimistic. His Daily Kos post on October 4 cited a USA Today column arguing that the issues plaguing the site were merely a sign of the law’s popularity — a good thing. “Frankly, I’m impressed that it’s holding up as well as it has — Amazon has had 18 years of slowly building traffic to build up their infrastructure; the HHS Dept. had to guess at how much traffic they were going to be hit with all at once.”

But by October 11, Gaba was referring to the rollout as a “colossal fuckup.” He also wondered why the administration was withholding data on enrollee numbers. “I understand that the numbers stink,” he told me, describing his thinking at the time. “But everybody knows the number stinks. If the number is zero, then just say it’s zero, because everyone thinks it is anyway.” Gaba figured that once the website was fixed, as it inevitably would be, then the White House could use those numbers to show it was making real progress.

Gaba is a self-described data nerd and loves working with spreadsheets, so he decided to take matters into his own hands. On October 13, he published a Daily Kos post titled “ObamacareSignups.Net: Crowdsourcing Help Needed.” The initial website was little more than a spreadsheet with some numbers and source links, and his plan was to scour the web looking for any scraps of data to emerge from either government agencies or the insurance companies themselves. “I’d appreciate it if 15 people (one for each state exchange, plus one for D.C.) could volunteer to check the media in each of those states for the latest official (hopefully accurate) figures on how many people have actually signed up for a healthcare policy via the ACA,” he wrote.

Slowly but surely, Gaba’s website began to take life. While he performed the bulk of the work — scanning press releases and government websites—others among the Daily Kos community would pitch in and email him numbers. Gaba readily admits that, at first, the numbers he collected couldn’t withstand apples-to-apples scrutiny. “It was all wrong about a lot of stuff,” he said. “For instance, there would be a report that said there were 12,000 policies enrolled in such-and-such state. But I didn’t know if that meant individuals or families.” His entire family — Gaba, his wife, and his son — were on one policy; were they being counted as one or three people? Given the sparse details he had access to, Gaba didn’t always know.

Still, Gaba’s spreadsheets were some of the only attempts at amassing real data. Another reporter, Dan Diamond, was trying to aggregate enrollment numbers. Now at Politico, Diamond at the time was running the news team for the Advisory Board Company, a healthcare research and consulting firm. “I ran the team [at the Advisory Board Company], and we had the idea to track the numbers because it was such a big story and nobody seemed to be doing it,” he told me. “It was such a massive amount of work. At some point, a bunch of people on Twitter said, ‘This is great. Have you seen that Charles Gaba is doing the same thing?’”

Diamond was among the first journalists to directly cite ACASignups.net — which at the time was still just a spreadsheet — in his reporting. “I was thinking, ‘Gosh, who is this guy from the Daily Kos—is he a legitimate source?’” he recalled. “I had been reading him for a little bit at that point, and it just seemed so obvious that he was doing what almost nobody else was, which was keeping his eye on the national picture and providing a valuable piece of citizen journalism.” When Diamond’s team stopped collecting numbers, he was confident that he could continue to draw on Gaba’s work in his reporting. “I know how hard that kind of work is because I did it for about a month. He’s been doing it now for three and a half years.”

Other reporters began to take notice. Sarah Kliff, now a star healthcare journalist at Vox, was blogging for the Washington Post’s Wonkblog at the time. In late December, she published a post citing Gaba’s claim that 5.75 million people had signed up on the exchanges. After Kliff’s article went live, Gaba started to feel like he was developing a real following. “My Twitter account, which up until that point was only followed by friends and family, was all of a sudden going bing, bing, bing,” he said. “That was the point where I was like, ‘Oh crap, I need to make it a real website.”

Eventually, Gaba transformed ACASignups into a proper blog, building it on the Drupal CMS. At first, the posts merely consisted of straightforward updates with enrollment numbers. Slowly, however, as his familiarity with the law grew, Gaba began sprinkling in analysis and predictions into his blog posts. In January, he entered a friendly bet with one of his readers and predicted that the ACA would hit 3.3 million signups by the end of the month. “Well as it happens, when the January number came out, the grand total ended up being 3,299,500,” Gaba recalled, laughing. “I was off by a thousandth of a percent. And that was the point where, all of a sudden, all these articles were saying I was the Nate Silver of Obamacare. They were calling me ‘Crystal Ball Gaba.’”

By March, as the first enrollment deadline approached, Gaba found he was losing sleep — and clients. “The clients were like, ‘It’s nice that you’re being interviewed on the news, but where’s my website?’ It was just crazy.” He was fielding interview requests at all hours of the day, and his website stats indicated that people were sitting on his blog and hitting the refresh button repeatedly, waiting for updated numbers. For a while, Gaba kept a running tally on his site of all his media mentions, but then Paul Krugman, in his New York Times blog, referred to him as the “invaluable Charles Gaba.” In a separate post, Krugman wrote, “When you read news reports on Obamacare, you can tell right away which reporters have been reading Gaba and know what’s happening and which reporters are relying solely on official announcements — or, worse, dueling political spin.” Gaba was floored. “To me, there’s really nowhere else to go beyond that,” he told me. “That’s pretty high praise, so I’ll take it.” After that, he stopped documenting his media hits.

The day after the enrollment deadline — which the Obama administration had extended for an extra two weeks — Gaba woke up with a case of shingles, a disease that typically afflicts only elderly people but can also be triggered earlier in life by extreme amounts of stress. Though Gaba was proud of the work he’d done, his business and personal life were suffering, and he figured it was time to wind down the blog.

But his fans would have none of it. Daily Kos founder Markos Moulitsas, after hearing of Gaba’s business troubles, launched a fundraiser for him in April 2014, raising close to $60,000. “It was enough to make up for the business I had lost for that first year and also enough to help cover my time for a second year,” Gaba said. Newly encouraged, he pressed on. With the next enrollment period not set to start for another several months, Gaba expanded his analysis and really began to dig into the nuances of the law.

This expansion of coverage, according to Andy Slavitt, was when Gaba really fell into his own. After 20 years in the private healthcare industry, Slavitt was tapped by the Obama administration in 2015 as acting administrator for the Centers for Medicare and Medicaid Services, and he essentially ran ACA implementation. Though Slavitt was impressed with Gaba’s doggedness in staying on top of enrollment, it was the analysis that truly won him over. “I think he became more influential the more he delved out of talking about the numbers and the more he started talking about the policy and political issues that we had,” Slavitt told me.

The blog soon became dotted with charts, weighted averages, and, in many cases, rapid-response reactions to misleading statements from conservative politicians and pundits. For one chart Gaba published in early 2016, for instance, he performed the painstaking working of breaking down the entire insurance market into a detailed pie graph. It did an amazing job of showing how the individual insurance market — arguably the slice of healthcare most impacted by Obamacare — makes up a tiny sliver of the overall health insurance ecosystem. (The chart would eventually get nominated for a healthcare journalism award.)

My favorite Gaba charts were published in October 2016. That same month, the Obama administration released data that showed health insurers planned to introduce shockingly high rate hikes, averaging 26 percent, in 2017. Some states would see premium increases above 50 percent. The GOP, of course, latched onto these numbers and held them up as proof that Obamacare was failing at its mission to clamp down on rising costs and would soon trigger a “death spiral.”

Gaba, however, decided to divide states into three categories: those that resisted the ACA, those that partly embraced the ACA, and those that fully embraced the law. If you’ll remember, states had the option to build their own exchanges or rely on the federal Healthcare.gov website, and the 2012 Supreme Court ruling allowed them to opt out of the Medicaid expansion, which many of them did. Lastly, several states took advantage of waivers that allowed them to grandfather in health insurance plans that didn’t meet Obamacare’s minimum requirements.

When Gaba divided states that fully embraced the law — built their own exchanges, accepted Medicaid, and didn’t allow for “transitional” plans — to those that rejected various parts of it, he found that the pro-Obamacare states experienced rate hikes 11.6 percentage points lower than states that had done everything in their power to reject the law. In other words, here was strong evidence that GOP efforts to sabotage the ACA had been successful, and the Republican party shared at least some responsibility in the rising costs.

Of course, by the time Gaba published these charts, the country was a few weeks away from a presidential election. It was impossible for him to write about Obamacare without addressing the fact that one of the candidates planned to repeal it on day one. But curiously enough, Gaba quickly grew tired of trying to keep track of Trump’s statements about the law. Put simply, the misinformation Trump spewed could be overwhelming. “It was clear from the beginning that he didn’t know what the law is,” Gaba said. “He knows less than I knew four years ago…And at some point, if someone’s throwing feces at the wall, how many times do you clean it off? I only have so much time, and this is the problem a lot of reporters are having. He lies so much so often that it’s very difficult to keep up.”

Like most Americans, Gaba assumed Hillary Clinton would win, and therefore her veto pen would keep the law safe for the foreseeable future. But he wrote one post in the September that, in retrospect, was incredibly prescient. In it, he wrote about House v. Burwell (since renamed House v Price), a lawsuit filed by congressional Republicans that asserted Congress hadn’t properly allocated cost-sharing reductions — a form of subsidy paid to insurance companies to help them cover costly patients—and therefore shouldn’t be paid out.

In 2016, a district judge ruled in favor of the Republicans but stayed her ruling pending appeal. This meant the administration, while appealing the decision, could direct the government to continue paying the subsidies. Under a Clinton presidency, those payments would undoubtedly continue, but in Gaba’s September post, he spelled out what would happen if Trump won. “If Donald Trump were to win,” Gaba told me, “he could basically destroy the Affordable Care Act with one shot: with an executive order instructing the HHS secretary to not make a payment that month.” Not only would this result in many insurers pulling out of the market in 2018, but it would also trigger a clause in their contracts that would allow them to terminate their plans immediately. Virtually overnight, millions of Americans would receive notice they were no longer covered.

When Gaba wrote the post, it was merely a hypothetical scenario that rested on the implausible notion that Trump would win. At the time, Clinton was consistently beating him at the polls and, with the release of the now-infamous Access Hollywood tape a few weeks later, a Trump win became unthinkable.

But then, on Tuesday, November 8, the unthinkable occurred.

To peruse through the ACASignups archives for the weeks following the election is to witness someone experiencing the various stages of grief. “I was stunned,” Gaba said. “I was in shock. I was horrified. I don’t think my wife and I slept for three days. It was devastating.” He immediately uploaded a new logo with the phrase “ACASignups.net” crossed off in a red squiggly line and replaced with “ACASignoffs.net.” “God help us all,” Gaba wrote the day after the election.

Gaba’s most dramatic reaction came on November 15 in a post titled “IMPORTANT: I cannot guarantee accurate federal data after 1/20/17.” After block-quoting a prescient passage from Orwell’s 1984, the post goes on to make this disclaimer:

Given Trump’s long, disturbing history of flat-out misstatements (aka “making sh*t up out of whole cloth”), and the type of sycophants he’s likely to put into place, I can’t guarantee with any certainty that the numbers spouted off by them are going to bear any connection with reality. Maybe they’ll be accurate. Maybe they’ll be off slightly. Maybe they’ll be completely removed from any actual numbers. Who the hell knows?

This wasn’t hyperbole. In a few short weeks, Trump would go on to lie about everything from his crowd sizes to the amount of voter fraud in the election. Just recently, his administration released a budget that contains a $2 trillion math error. But despite this disclaimer, Gaba forged ahead, not only writing hundreds of new posts on his blog but also tweeting pretty much around the clock with near-instant responses to new healthcare-related revelations. Since the election, Gaba has become a central figure in the activist movement to resist the GOP’s efforts to repeal and replace Obamacare.

Perhaps Gaba’s most impactful work thus far has been his district-by-district breakdown of who would be affected by Obamacare repeal. Using numbers provided from the Kaiser Family Foundation and other sources, he published an exhaustive list of charts and figures estimating how many people would lose coverage in each district. Activists immediately latched onto these numbers and began tweeting them at their individual Congress members. They would also cite them during the raucous, confrontational town halls that you’ve likely seen videos of. “When you say 24 million people, it’s a huge number, but it’s like when you talk about the national debt,” in that such a figure is too difficult for the human mind to truly understand. “When you say 18,000 people in your congressional district are going to lose their insurance, it makes it easier for people to wrap their heads around it.”

I asked others what they thought of Gaba’s role in thwarting the GOP’s efforts to dismantle Obamacare. Politico’s Dan Diamond wondered if Gaba’s activism is undermining his credibility among some. “Charles, he’ll say this, he has a liberal bias, he has a bent. That’s the one concern I’ve heard from members of the media in drawing on his numbers. That because he’s an advocate—it’s not quite the same unbiased moderate tone that you might expect from someone else.”

Andy Slavitt, who after leaving the government became an adviser at the Bipartisan Policy Center and is now spearheading his own district-by-district activism to save the ACA, told me that Gaba’s strength is taking arcane policy and making it digestible. “I think occasionally [organizations like the Kaiser Family Foundation] will provide much of the data, and he’ll bring it the final mile. He brings it to the ‘so what?’ stage, and there you see him as an important source, because he’ll take the raw data and give analysis. That’s been very effective.”

Gaba is modest when assessing his influence. “I think I’m playing a role, but I don’t know how outsized it is,” he said. “I think I’m unique being a blogger versus not being on a payroll of a media outlet, so I have a certain freedom to speak my mind a little more bluntly than some healthcare reporters. I think, in an odd sort of way, the fact that I don’t have a formal background in some of these fields, by stumbling my way across learning all this stuff, I’ve done it without certain preconceptions. I think I come at it from a different angle perhaps. I have more of a ‘holy crap, you’re kidding!’ attitude for stuff I learned.”

Which brings us back to the notion that I find most amazing: Gaba doesn’t make a living doing this and is in fact continuing to support his family via his web design business. Sure, he gets paid for the occasional freelance article and solicits donations on his website, but Gaba doesn’t bring in nearly enough to justify the hours he spends each day educating the public on these issues. I asked him if he ever wanted to launch a career from his healthcare analysis. After all, if Nate Silver could take an anonymous Daily Kos blog and grow it into an ESPN-owned data journalism empire, surely Gaba could find better ways to monetize reporting on an industry that makes up one-sixth of the American economy?

“Let me put it this way: If there are book publishers out there who’d like to talk, I’d be open to talking,” Gaba replied, laughing. “Honestly, I’m still struggling with that myself. I really, truly thought I’d be shutting it down this year, because my assumption was that if Hillary Clinton had won, not too many people would care about the day-to-day minutia of healthcare enrollment in the same way they’re not following Medicare or Social Security signups. Well, that didn’t happen, and now we have this other thing, and all of a sudden my site’s become more valuable than ever for people relying on it to help inform them. So I’m not sure where I go from here.”

Gaba has resisted monetization because he felt it would somehow taint his work. For years, he felt guilty about asking for money. But with his website taking on a new relevance and the GOP’s continued fight to destroy a law that’s brought affordable, comprehensive health insurance to 20 million additional people, Gaba is beginning to come around to the idea that his efforts should be remunerated.

“I’d like to think I’ve paid my dues at this point in terms of a public service,” he said. “I’ve been doing this for a couple years, and at a certain point, if I’m going to be continuing this long term, then a man’s gotta eat, right?”