OUR REPUBLICAN PRESIDENT:

The Hospital Corporation of America (HCA), the largest for-profit healthcare provider in the country, is coming out in favor of the Affordable Care Act's attempt to expand insurance coverage to the majority of American patients.  Obamacare, currently under challenge from a Supreme Court case claiming that some consumers are receiving illegal subsidies for their health insurance, has been shown to significantly reduce emergency room use, increase patient engagement, and effectively share financial risk across the healthcare continuum, HCA argues in a legal brief.  These principles of accountable care would not be effective if the Supreme Court strikes down the subsidy provision of the "interdependent" framework of the ACA.

"Congress designed the ACA so that individuals who previously did not pay for care would take personal financial responsibility for that care," the document says.  "HCA's data reveals that patients on the federally-facilitated Exchanges, unlike uninsured patients, make significant contributions to the cost of their treatment.  The ACA embodied a carefully-constructed 'shared responsibility' framework under which healthcare providers would shoulder some of the costs but also share in some of the benefits.  HCA's data show that hospitals have taken significant cuts in federal reimbursements under the ACA, but that these cuts are beginning to be offset by new revenues from expanded Exchange insurance."

This give-and-take financial structure is good for patients, HCA says, because an increased patient responsibility forces consumers to make smarter decisions about their healthcare.  While 89.6% of uninsured patients visiting HCA facilities paid nothing for their care in 2014, contributing to $43 billion in annual uncompensated healthcare across the nation, an Exchange patient is likely to pay an average of $390 out-of-pocket for similar services.  Patients may be more likely to choose free, routine preventative care that keeps them well instead of risking a hefty medical bill for visiting the ER, and the HCA has data that proves the strategy's effectiveness.

"In 2014, uninsured patients visited the ER approximately ten times for every inpatient admission," the brief says.  "By contrast, individuals insured through the federally-facilitated Exchanges are visiting the EHR approximately three times for every inpatient admission.  Thus, HCA's data indicate that uninsured patients are about 300% more likely than Exchange patients to rely on ER care."

Follow @brothersjudd