How does federal judges' health insurance stack up?

Just what kind of health insurance do federal judges and Supreme Court justices have?

That question seems fair to ask in light of U.S. District Judge Reed O'Connor's ruling on Friday striking down the Affordable Care Act -- the 2010 law passed under President Barack Obama that expanded health insurance to millions of Americans -- as unconstitutional. O'Connor's decision looks certain to be appealed by a group of Democratic state attorneys general, first to the U.S. Court of Appeals for the Fifth Circuit and then likely to the Supreme Court.

While the ACA's ultimate fate may depend on those courts, here's what to know about the health coverage federal judges and Supreme Court justices can typically expect.

Hundreds of plans to choose from

Like the vast majority of federal employees of all ranks, the government's judges have the option of enrolling in plans offered by the Federal Employee Health Benefits system. It includes hundreds of plan choices throughout the U.S. -- far more than even the largest private employers. Many plan options also have broad networks of providers, often nationwide. 

So finding coverage for specialists and out-of-network services isn't as tough a problem for judges as it can be in the often narrow networks ACA enrollees rely on. And federal employees have the option of keeping their coverage into retirement, unlike many private employer plans.

Still, the insurance isn't as comprehensive as one might imagine a federal judge or Supreme Court justice would get. Unlike the so-called Cadillac plans that top corporate executives often enjoy that fully cover a host of health care expenses, the federal plans have deductibles, premium costs, co-pays and other out-of-pocket expenses.  

Like any employer offering health insurance, the federal government pays a good portion of employees' premiums. Except for some negotiated union contracts with postal workers, the feds generally pay about 72 percent of premium costs. But that's less than the average 80 percent that private sector employers kick in.

Even judges pay premiums

That means judges who opt into the system pay premiums, just like the rest of us. They may even pay a bit more than the average private-sector employee. In addition, depending on what type of plan judges pick, like private-sector employees they may have high deductibles or high co-insurance for certain services. As in the marketplaces, it's all about what plan they choose.

But recall the biggest difference: Feds have dramatically more choices than most employees or people shopping the ACA marketplaces for coverage.

Plus, with an annual salary of $255,300 for associate Supreme Court justices, this elite group of jurists likely doesn't feel the pain of out-of-pocket costs as much as the average ACA recipient. The high court doesn't disclose how many justices opt for the Federal Employees Health Benefits Program. They are allowed to receive coverage elsewhere, such as through a spouse's plan.

Whatever the case, federal judges' own health coverage probably doesn't weigh too heavily on their decision-making. After all, we've been here before. The Supreme Court upheld the ACA in 2012, saying the individual mandate -- the area of the law under dispute in the Texas case -- was constitutional because of the tax penalty involved. But now that the Trump administration abolished the penalty, the recent lawsuit argued the entire law was no longer constitutional. 

The bigger the pool, the better

Still, it might be more instructive if federal judges give a little thought to why their health insurance option works so well. That's primarily because federal employees are a large, diversified pool of patients, with varying ages, demographics and health care needs. Such a pool helps insurers spread risk among young, healthy participants and those who are older or have more health care needs. The large pool also helps the government negotiate with insurers to keep costs down.

It's an ideal situation, one that the ACA tried to replicate in many ways.

Now, though, the fate of an estimated 20 million Americans covered under the ACA lies in the hands of these well-covered judges. Judge O'Connor's Friday ruling that the ACA is unconstitutional came in response to a lawsuit filed earlier this year by a group of Republican governors and state attorneys general.

The decision doesn't affect people currently insured in the ACA marketplaces or those who have just signed up for 2019 coverage. Ultimately, however, if the ruling holds it would dismantle the entire law -- that includes many of the popular ACA components such as protections for people with preexisting conditions, mandated coverage of "essential health benefits" and zero-cost preventive care. Medicaid expansion coverage under the ACA would also be in jeopardy.

The judges, of course, would still have their federal coverage.