CHA joins in position briefs supporting Affordable Care Act

March 15, 2012

Supreme Court to hear oral arguments this month on constitutional challenges to health reform

CHA has joined five other national hospital groups in a legal battle to support hard-won health reform legislation that it considers to be crucial to expanding health care to uninsured Americans.

The association is signed on to two "friend-of-the-court" briefs in the U.S. Supreme Court, where a state challenge to the federal Patient Protection and Affordable Care Act will be argued late this month. The briefs urge the justices to uphold two specific provisions of health care reform: the health insurance mandate (which requires nearly all Americans to have health insurance by 2014 or face fines) and the expansion of Medicaid to individuals with incomes up to 133 percent of the federal poverty level.

The states' challenge strikes at the heart of the essential elements of reform for which CHA most strongly advocated in Congress — provisions that would extend coverage for nearly 92 percent of all U.S. residents, said Lisa Gilden, CHA vice president and general counsel. It is estimated that 50 million Americans have no health insurance.

"Expansion of coverage is consistent with our mission of taking care of the poor and vulnerable," Gilden said. Catholic hospitals and health systems "provide care to many of the uninsured."

In the briefs, the organizations urge the court to reject the argument of Florida and other states that have challenged the law on several grounds.

CHA joined the American Hospital Association, the Association of American Medical Colleges, the Federation of American Hospitals, the National Association of Children's Hospitals and the National Association of Public Hospitals and Health Systems in asking the court to uphold the law. Together, the groups represent nearly every hospital and health system in the country and this unanimity demonstrates the importance of the case, Gilden said.

"Together, the hospital community believes that the insurance mandate is necessary to solve a crisis of the uninsured. It is very important," she said. "If everyone is covered, then we have a large pool, and it spreads (financial) risk. Without the mandate, the law will achieve much less."

Opponents of the law's "individual mandate" provision say it exceeds Congress's constitutional authority because individuals who do not purchase health insurance are not engaged in interstate commerce. This view holds the federal government cannot force an individual to buy an insurance policy based on the possibility that the individual "may" one day need health care and could therefore affect interstate commerce.

The language in the associations' briefs echoes the federal government's argument that everyone will, at some point in their life, need health care, and will get it from a system with an insurance-funded infrastructure. The hospital associations contend the rising number of uninsured has a demonstrable impact on the health care marketplace.

"To be sure, hospitals bear many of these expenses (of caring for the uninsured) as part of their mission," lawyers for the group of hospital associations write in the joint briefs. "But that does not change the fact that uninsured individuals' collective need to seek care causes a substantial — indeed, massive — effect on interstate commerce."

In their briefs, the hospital groups point out that the cost-shifting that occurs to offset some of the costs of caring for the uninsured distorts health care sector pricing. "That is the quintessential 'substantial effect' on interstate commerce," according to the hospital associations. "Nothing more is required to uphold the individual mandate as a constitutional exercise of Congress' commerce clause power."

Supporters argue the health reform law takes necessary and urgent steps toward solving the crisis of America's uninsured, who in 2008 received $86 billion in health care — of which "some $56 billion was in the form of uncompensated care provided by hospitals, doctors, clinics and health care systems," according to the associations.

The plaintiffs' challenge to the Medicaid expansion has attracted the attention of a wide range of organizations, who likewise argue that, if upheld, the decision could disrupt a variety of programs with state and federal cost-sharing, from highway safety to support for low-income schools.

On the issue of Medicaid, the states challenging the law contend that the Medicaid expansion is unconstitutionally "coercive" because states strapped with tight budgets can't afford to expand the program but also can't afford to step away from the federal health care program and the federal money that comes with it. Such an expansion is unconstitutional unless every state involved agrees to it, the opponents argue.

This argument, Gilden said, would suggest that there could never be any changes to Medicaid if even one state opposed the changes. But, as stated in the hospital associations' brief, "Congress has seen fit to modify Medicaid dozens of times over the decades to expand eligibility and expand or contract states' flexibility regarding coverage and provider compensation." The associations maintain that giving one state a veto right "has the potential to wreak havoc on hospitals and their patients."

A state's decision to participate in Medicaid or not, is voluntary, although every state participates in some manner, Gilden said. The associations point out in one of their briefs that legislators in Texas and Florida, both plaintiffs in the case, have recently raised the possibility that their states would withdraw from the Medicaid program.

The Supreme Court has scheduled oral arguments on the health reform law for March 26, 27 and 28. A decision is expected by the end of the court's term in June.


Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2012 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.