Tuesday, February 9, 2016

Even Supreme Court seems to misunderstand Obamacare

No one seems to really understand Obamacare, not even the Supreme Court.

Even Supreme Court seems to misunderstand Obamacare


No one seems to really understand Obamacare, not even the Supreme Court. 

In oral arguments last month, Chief Justice John Roberts asked Solicitor General Donald Verrilli to explain why the law requires people to obtain insurance for services they may never need. He noted that the policies Americans will have to purchase “must contain provision for maternity and newborn care, pediatric services and substance abuse treatment.”

Justice Roberts is correct that health reform will require insurance policies to include a set of minimum benefits that the federal government will specify. These will likely be based on the elements of typical small business plans of today, which generally include all of the services that he mentioned.

However, his questioning left the impression that all policies must be comprehensive. That is far from accurate.
Americans will be able to satisfy the mandate to have health insurance with a number of different options. These range from “platinum” policies that cover 90 percent of expected medical expenses to “bronze” policies that cover only 60 percent .

The bronze level is quite barebones. The nonprofit and nonpartisan Kaiser Family Foundation estimates that the annual deductible could be as high as $6,350.
And those under 30 can purchase even skimpier policies that cover only catastrophic expenses.

Larry Levitt, head of Kaiser’s Initiative on Health Reform and Private Insurance, thought the Supreme Court questioning could easily leave “the impression that the health care reform law was requiring people to buy Cadillac insurance.” The bronze plan is more like a Mini Cooper with a much lower cost to match its smaller size.

Inexplicably, Verrilli failed to point this out in his response. He never mentioned bronze plans and never contradicted the implication that the law would make everyone buy top dollar coverage.

Obamacare is much less onerous than its opponents claim in other ways, as well. For example, opponents often portray the individual mandate as a new burden that every American will have to bear.

In reality, the vast majority of Americans either already has or would like to have health insurance. They would get it with or without the mandate. And the mandate exempts many of the rest. The Urban Institute, a prominent think tank, estimates that the law would force a mere 6 percent of Americans to ether obtain coverage they might otherwise have avoided or pay a penalty.

Verrilli never made that point, either.

It’s disappointing when a Supreme Court justice seems to misunderstand a key element of a case before him. But it’s incomprehensible when an attorney in the case fails to offer a correction.

The Obama administration has done a woefully poor job of explaining its signature policy initiative to the American public. Its communication strategy before the Supreme Court doesn’t seem to be much better.


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About this blog

Check Up is a blog for savvy health consumers, covering the latest developments, discoveries, and debates from the Philadelphia area and beyond.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, Drexel University Kline School of Law & Dornsife School of Public Health
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