Bioethics Blogs

SCOTUS Has Ruled on Obamacare. So What’s Next?

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In a 6-3 decision, the Supreme Court Thursday spared the Affordable Care Act from what would have been a death blow.

The Court’s action upholds the right of the federal government to subsidize low-income Americans who purchase health insurance through, the federal exchange. Infamous for its rocky start, now presents millions of Americans with price information for a list of insurance plans available to them where they live. is now largely glitch free, but it — and state insurance exchanges — still need major overhauls, so they no longer lead Americans to make bad insurance choices.

Consider the way the exchanges divide health plans into tiers, based on metallic labels — of bronze, silver, gold and platinum. The bronze tier features plans with relatively low monthly premiums and high out-of-pocket medical costs, while the gold and platinum tiers feature more expensive and comprehensive plans. Thanks to these metallic labels, a consumer who faces a choice among, say, 18 insurance plans can choose instead to look at only the six silver plans, or the five bronze ones, a much less daunting task.

This sounds good in theory but, in fact, consumers don’t act in ways web designers might expect. Several months ago, two colleagues and I published an article in the New England Journal of Medicine reporting on an experiment we ran among bus riders in Durham, North Carolina. We gave people brief descriptions of bronze, silver and gold health plans and asked them which type of plan they would be most likely to choose.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.