A less talked about impact of the Supreme Court ruling about employer based insurance and birth control coverage is the widening gap of freedom of choice between those locked into employer based insurance and those able to purchase insurance available in the Marketplace/Exchanges.
In the past, most employer based insurance has been among the most comprehensive, especially compared to plans many individuals were able to afford on their own in the private market. Because of ACA however, now all plans cover at minimum the same set of essential benefits…until this ruling. Now some employers will be able to limit coverage. (Note, some grandfathered plans aren’t yet up to date on all preventive benefits but they are set to sunset as soon as those plans make a change.)
So can affected employees shop in the Marketplaces for coverage they may prefer? Yes, but because they have an employer based option they are not eligible for tax credits if they do so. These workers would basically be turning down the employer-supported plan and going solo on costs.
Giving less freedom of choice to workers was rational within the broader intent of ACA to expand, rather than supplant, the current insurance market that relied heavily on employer based plans. To keep the balance weighted with employers as major providers of insurance, there is both the large employer mandate (delayed until January 2015) and the rule that makes workers who are offered affordable and adequate health insurance through their employer ineligible for the tax premium credits in the Marketplace.
Therefore, the SCOTUS decision intensifies this inequity between those who can freely go to the Exchanges and those who are locked into employer based plans. This becomes acute as women may now have even more reason to want to make their own choices as to their best insurance options. Women who would prefer their plans to cover a full range of contraceptives will be at a financial disadvantage to those without employer based options who get premium assistance. Over 80% of people purchasing Marketplace policies qualified for such assistance.