Supreme Court Ruling Threatens Hospitals Serving Neediest, Jackson Warns

Washington, D.C. — In a sharply worded dissent, Justice Ketanji Brown Jackson, joined by Justice Sonia Sotomayor, warned that a new Supreme Court decision will harm the “neediest among us” by reducing federal funds to hospitals serving low-income communities.

The 7-2 ruling, authored by Justice Amy Coney Barrett, sided with federal health officials in a dispute over calculating payments to hospitals treating a disproportionate share of low-income patients. Jackson urged Congress to intervene and rectify the majority’s error.

The case centered on a technical issue: how the government determines payments under the disproportionate-share hospital (DSH) formula, which compensates facilities serving higher numbers of low-income patients.

The majority rejected the hospitals’ appeal, with Barrett describing the issue as “highly technical” but grounded in statutory interpretation. However, Jackson argued the ruling’s consequences are far-reaching, potentially forcing hospitals in underserved areas to close due to insufficient funding.

“The decision the majority has made in this case will deprive hospitals serving the neediest among us of critical federal funds that Congress plainly attempted to provide,” Jackson wrote. She emphasized that undercounting low-income patients in the DSH formula could devastate healthcare access for the nation’s poorest communities.

“Patients from our Nation’s poorest communities may not be served at all,” she added, highlighting the human cost of the ruling.

Jackson, appointed by President Biden, concluded her dissent with a call to action, urging Congress to “restate its intention that low-income people have access to quality medical care and that hospitals be compensated accordingly.” She suggested that legislative clarity could override the Court’s interpretation and restore the intended funding.

The ruling also underscores a deeper ideological divide on the Court.

Barrett criticized the dissent for prioritizing the statute’s purpose over its text, arguing that the majority’s approach adhered strictly to the law’s wording. In response, Jackson contended that the Court’s interpretive practices should consider both the text and Congress’s clear objectives. “If this Court’s interpretive practices would just take care to evaluate the text of a statute alongside any indisputable legislative objectives,” she wrote, Congress would not need to intervene.

The decision comes at a time when healthcare access remains a pressing national issue, particularly for underserved populations. Hospitals relying on DSH payments often operate on thin margins, and reductions in funding could exacerbate existing disparities in care.

Advocacy groups and healthcare providers are likely to echo Jackson’s call for congressional action, though legislative gridlock could complicate efforts to address the issue promptly.

The case also highlights the influence of the Court’s conservative majority, with Barrett’s opinion reflecting a textualist approach favored by conservative jurists.

Jackson and Sotomayor’s dissent, by contrast, emphasizes broader societal impacts, aligning with a more purposivist interpretive philosophy. This philosophical clash is not new but continues to shape the Court’s rulings on issues affecting vulnerable populations.

As the nation grapples with healthcare inequities, Jackson’s dissent serves as a poignant reminder of the stakes involved in seemingly technical legal disputes.

Her call for Congress to act places the onus on lawmakers to ensure that hospitals serving the neediest can continue their vital work. Whether Congress will respond remains uncertain, but the ruling has already sparked debate about the Court’s role in shaping access to care for America’s most vulnerable.

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Tags: Supreme Court, Ketanji Brown Jackson, Sonia Sotomayor, Amy Coney Barrett, healthcare,
low-income hospitals, disproportionate-share hospitals, Congress, dissent, statutory interpretation