time.169 ACA plans are an essential piece of the picture of health benefits
for all Americans.
A functional approach to interpreting ACA plans may move us toward
a more realistic view of health insurance in general. It may also move
insurance law toward a more principled conception of highly regulated
insurance policies.170 At the very least, a rule of construction based on the
legislative purpose of ACA plans is a step toward achieving fairness both
across populations and in individual cases. Decisions that are consistent
with ACA goals may foster trust among consumers and patients that their
health insurance is serving their most basic needs, even if it does not pay for
all their hearts’ desires. This is, after all, the end that the ACA seeks to
169. King v. Burwell, 759 F.3d 358 (4th Cir. 2014), cert. granted, 190 L. Ed. 2d 355
(2014) (challenging the authority of the Internal Revenue Service to issue tax credits to
individuals who purchase health insurance through the federal exchange or a federal-state
partnership exchange); see supra note 15.
170. See Abraham, supra note 6, at 670 (describing the ACA as the strongest example
of treating health insurance as a heavily regulated industry heavily akin to a public utility).
171. Susie Hodge, Why Your Five-Year-Old Could Not Have Done That: Modern Art
Explained 63 (2012) (quoting Miró). My thanks to Professors Stempel and Annas for
inspiring this metaphor.