Does the Supreme Court Understand Health Reform?

The Patient Protection and Affordable Care Act is a lengthy, complex law, which is hardly surprising given the size and scope of the health care economy it addresses. Unfortunately that also means it requires a lot of work to understand it in detail. After watching the Supreme Court’s oral arguments over the law, some commentators are concerned that the justices may not have a full appreciation for some important nuances.

The Patient Protection and Affordable Care Act is a lengthy, complex law, which is hardly surprising given the size and scope of the health care economy it addresses. Unfortunately that also means it requires a lot of work to understand it in detail. After watching the Supreme Court’s oral arguments over the law, some commentators are concerned that the justices may not have a full appreciation for some important nuances.

During the recent oral arguments some of the justices and the lawyers appearing before them seemed to be under the impression that the law does not allow most consumers to buy low-cost, stripped-down insurance to satisfy its controversial coverage requirement.

In fact, the law provides for a cheaper “bronze” plan that is broadly similar to today’s so-called catastrophic coverage policies for individuals, several insurance experts said.

“I think there is confusion,” said Paul Keckley, health research chief for Deloitte, a major benefits consultant. “I found myself wondering how much they understood the Affordable Care Act. Several times the questions led me to wonder how much (the justices’) clerks had gone back into the law in advance of the arguments.”

There are two aspects of the law that work in offsetting ways. The requirement to purchase a health plan that covers “essential health benefits” appears to require comprehensive coverage. On the other hand, the “bronze” level will have deductibles in the $3000 to $6000 range and could be more appropriately classified as catastrophic rather than comprehensive. People under 30 can buy even more stripped down plans.

Plaintiffs disagree with this assessment, of course, but their argument is a bit of a head scratcher:

“The bronze plan is not catastrophic coverage,” said Michael Carvin, who represents the National Federation of Independent Business.

“It’s got all the minimum essential benefits in it,” he added. “It’s got to have wellness, preventive, contraceptives — all kinds of things a 30-year old would never need.”

I’m not sure which 30 year olds Carvin is hanging out with. But wellness benefits –addressing lifestyle issues such as smoking, alcohol, and eating habits– are completely relevant to someone in that age group. Some preventive services, such as colonoscopy are more relevant for older people, but others such as vaccines and Pap smears are important.

Finally, if Carvin actually thinks a 30-year-old “would never need” contraceptives then that’s very funny indeed.