Six groups representing 5,000 U.S. hospitals and health systems filed an amicus brief late last week asking to join the Florida lawsuit challenging the constitutionality of the Affordable Care Act.
But while the state of Florida is arguing against the individual mandate, the requirement that individuals who can afford it be required to purchase health insurance or pay a penalty, these six hospital organizations hope to argue in favor of it.
The amicus brief was filed by the American Hospital Association, the Federation of American Hospitals the National Association of Public Hospitals and Health Systems, the National Association of Children's Hospitals and Related Institutions (NACHRI), the Catholic Health Association of the United States, and the Association of American Medical Colleges.
The case is being heard in the U.S. District Court for the Northern District of Florida in Pensacola. The case is one of several filed by a variety states, although some state courts have declined to hear some of the legal challenges.
If they are not overturned, the individual mandate's provisions take effect in 2016. They include subsidies to help people in certain low-income brackets buy coverage policies.
Larry McAndrews, executive director for the NACHRI, says that his "general sense is that with this lawsuit, we're concerned that the results may not end up in the way that would be supportive to the kind of changes we might be looking for.
"We want to be part of the deliberations that lead to the decision the judge makes. We're just saying to the court, we want to be part of the official input that you receive." McAndrews says that hospital lawyers feel that the Florida case may be the one among 20 filed by states that has a chance of moving forward, eventually perhaps to the U.S. Supreme Court.
While the individual mandate won't eliminate the entire problem of uncompensated care that hospitals now provide, "the whole thing (health reform effort) unravels if there's not some sort of insurance principle that works."
According to the hospital groups' brief, hospitals in 2008 provided uncompensated care valued at $36.4 billion, "a disturbing upward trend in uncompensated care, and Congress' attempt to reverse it through the Patient Protection and Affordable Care Act is precisely what is at issue in this litigation."
Not only do these hospitals have to provide emergency care to anyone, regardless of ability to pay, "even when an uninsured patient arrives planning to pay his or her own way, that patient may struggle to pay for an extended hospital stay."
They absorb expenses to help patients determine if they meet eligibility requirements for financial assistance, financial counseling, sliding-scale payment policies, interest-free loans and other incentives that help patients receive grants and qualify for Medicaid.
"The ACA represents a comprehensive effort to extend coverage to millions more Americans to make care available to patients in doctors' offices, clinics and other settings, keeping them out of emergency departments and hospitals unless they need to receive care there," the AHA said in a statement.
"For these reasons, the hospital associations and their members arguably will be more directly affected by the decision in this case than any other institutional group in the nation."
In its argument to be included, the hospital groups said they intend to explain "how the decision made by some uninsured Americans to delay or forgo routine preventive care actually increases the amount, and the cost, of the care they need when an avoidable illness eventually brings them to the hospital." It would also "explain how the costs of caring for the uninsured are absorbed not just by hospitals but also by private insurers and taxpayers."
McAndrews notes that how employers respond to the individual mandate provisions—whether they will continue to purchase group plans or instead pay a penalty—will determine how effective the individual mandate will be in getting more people to buy coverage.