The controversy this week around the comments of a health economist, Jonathan Gruber, about President Obama’s health law has centered on his most explosive remarks, captured on video, about the “stupidity of the American voter” and the suggestion that the law was passed dishonestly. It was those blunt remarks that have Republicans in Congress talking about a new round of hearings to assail the law and, one imagines, a man who helped create its intellectual architecture.

But beyond his inflammatory comments, what substantive policy point was Mr. Gruber trying to make about the design of the Affordable Care Act, and how does it fit in with what is now the health care law of the land?

Referring to the Congressional Budget Office, Mr. Gruber said in an academic panel discussion last year (a tape of which surfaced this week): “This bill was written in a tortured way to make sure the C.B.O. did not score the mandate as taxes. If C.B.O. scored the mandate as taxes, the bill dies.”

The line between what constitutes federal taxes or spending and what doesn’t is often debatable. If the government requires coal companies to pay lifetime health benefits for their employees, does that count as federal spending? What about federal rules requiring businesses to install (sometimes costly) ramps for wheelchair access?