Hospitals Argue $1.5 Billion Is Being Left on the Table
The lawsuit, spearheaded by Advocate Christ Medical Center and backed by over 200 hospitals nationwide, aimed to expand the formula’s reach. Their argument? That those legally entitled to SSI — even if not receiving payments — should count toward the DSH calculations.
The hospitals warned that HHS’s narrow interpretation denies them up to $1.5 billion annually, a blow to institutions already serving financially vulnerable communities.
Dissenters Warn of Systemic Undercuts
In a powerful dissent, Justice Ketanji Brown Jackson, joined by Justice Sonia Sotomayor, took aim at the majority’s logic, arguing that excluding patients simply because their SSI payments were momentarily paused creates “an artificial and harmful barrier” to funding.
“This approach risks abandoning the very patients DSH payments are meant to help,” Jackson wrote, warning of a ripple effect on public health.
A Déjà Vu Decision: Echoes of Empire Health
This marks the second time the Supreme Court has delved into the murky waters of DSH math. In 2022, the justices narrowly upheld HHS’s stance in Becerra v. Empire Health Foundation, concluding that patients could still be included in the DSH count even if they’d temporarily run out of Medicare Part A coverage.
That case revealed just how “baffling” the justices themselves found the formula. Now, with Advocate Christ Medical Center v. HHS, the fog has thickened, but HHS stands on firmer legal ground.
