SUPREME COURT OF THE UNITED STATES
_________________
No. 23–715
_________________
ADVOCATE CHRIST MEDICAL CENTER, et al.,
PETITIONERS
v. ROBERT F. KENNEDY, JR., SECRETARY OF HEALTH
AND HUMAN SERVICES
on writ of certiorari to the united states
court of appeals for the district of columbia circuit
[April 29, 2025]
Justice Jackson, with whom Justice Sotomayor
joins, dissenting.
Providing quality healthcare to low-income
patients can be costly. When Congress established Medicare’s
hospital-reimbursement system, it recognized that people with low
incomes tend to have comparatively worse health conditions and
health outcomes than wealthier people, and was clear eyed about the
fact that, as a result, “[h]ospitals that serve a disproportionate
share of low-income patients have higher medicare costs.”
H. R. Rep. No. 99–241, p. 16 (1985). To account for the
variable costs attributable to the healthcare needs of different
socioeconomic populations, Congress opted to reimburse hospitals
that have a “disproportionate share” of low-income patients at a
different (greater) rate than other hospitals.
This case concerns the formula that Congress
uses to identify and compensate those hospitals. The majority and I
are in considerable agreement about key aspects of the statutory
provision at issue. We agree that the point of the
“disproportionate share” Medicare formula is to identify hospitals
that serve a disproportionate number of low-income patients. We
agree that the formula looks to the Supplemental Security Income
(SSI) program—a benefits program for low-income Americans that
entitles certain individuals to receive cash payments from the
Government—and counts the number of a hospital’s Medicare-eligible
patients who are also “entitled to” SSI. We agree that, under the
SSI program, eligibility for a cash payment in a given month turns
on a person’s monthly income. And we agree that, if the SSI program
operates like Medicare Part A, our decision in
Becerra v.
Empire Health Foundation, for Valley Hospital Medical
Center, 597 U.S. 424 (2022), would control the outcome of this
case, and would require us to rule for the hospitals.
All that said, the majority’s interpretation of
Medicare’s disproportionate-share formula is based upon a
fundamental misunderstanding of how SSI’s cash-benefit program
works. And that misunderstanding has led the majority to evaluate
the Medicare statute without regard to the function of the
formula’s reference to the SSI program, causing it to reach the
wrong conclusion.
To be specific: When Congress created Medicare’s
disproportionate-share formula, it looked to SSI’s cash- benefits
program
for a reason. No one disputes that Congress’s
ultimate goal was to provide hospitals that serve the neediest
among us with the appropriate level of critical funds. The only
logical basis for the formula’s reliance on SSI, then, is to draw
from that program’s pre-existing pool of individuals that have
already been designated as our society’s neediest—
not to
assess the wholly irrelevant fact of whether any such individual
actually received a cash payment under the SSI program during the
month of their hospitalization. The majority’s interpretation both
ignores this critical context and endorses an interpretation of the
Medicare formula that arbitrarily undercounts a hospital’s
low-income patients.
In short, under the majority’s reading,
Congress’s reference to the SSI scheme in the Medicare statute
serves no rational purpose. Worse still, the majority seems to
think that a statutory formula specifically designed to authorize
payments to certain hospitals in greater amounts is best read to
affect the arbitrary denial of those additional funds.
Respectfully, I dissent.
I
“The Medicare program provides
Government-funded health insurance to over 64 million elderly or
disabled Americans.”
Empire Health, 597 U. S., at 428.
The program generally works by reimbursing hospitals for their
treatment of Medicare beneficiaries. See 42 U. S. C.
§1395ww(d). To incentivize hospitals to treat patients in the most
efficient manner, Congress reimburses hospitals for the services
they provide at a fixed rate that turns on a patient’s diagnosis
rather than the hospital’s actual costs.
Empire Health, 597
U. S., at 429.
But Congress also recognized that some hospitals
have it harder than others. Based on empirical research, it
specifically observed that “[h]ospitals that serve a
disproportionate share of low-income patients have higher medicare
costs,” and that this was so for two primary reasons. H. R.
Rep. No. 99–241, at 16; see also
Empire Health, 597
U. S., at 429. First, low-income patients tend to be in poorer
health to begin with, and have more complications after medical
procedures than patients who are wealthier. H. R. Rep. No.
99–241, at 16. Second, hospitals that see a significant number of
low-income patients often have to employ extra personnel, such as
social workers and interpreters, in order to serve this population,
adding to a hospital’s fixed costs.
Ibid.
Congress thus reasonably decided that those
hospitals that have a disproportionate share of low-income patients
should receive enhanced Medicare reimbursements.
Empire
Health, 597 U. S., at 429. And, notably, by compensating
for the disparity in treatment costs, Congress hoped to
“encourag[e] hospitals to treat low-income patients.”
Ibid.
To accomplish Congress’s fair-reimbursement
objectives, the hospitals with a disproportionate share of low-
income patients first had to be identified. One option would have
been to require all hospitals to track their patients’ incomes and
report them to the Government. H. R. Rep. No. 99–241, at 17.
But this would have added administrative overhead to already
burdened hospitals.
Ibid. So, instead, Congress devised a
formula that could be used to calculate the percentage of a
hospital’s patients who are low income using administrative data
already in the Government’s possession. See
§1395ww(d)(5)(F)(vi).
As the majority helpfully explains, part of that
formula—referred to herein as the “Medicare fraction”—calculates
the percentage of a hospital’s Medicare-eligible patients who have
low incomes. The base of that fraction counts the total number of
days Medicare patients spent in the hospital.
Ante, at 4.
The numerator counts the number of days “ ‘attributable to
Medicare patients who are poor,’ ” as determined by their
entitlement to SSI benefits.
Ibid.
We took this case to decide who falls within the
numerator. That is,
which hospital patients are “entitled to
[SSI] benefits” for purposes of the disproportionate-share formula?
§1395ww(d)(5)(F)(vi)(I). This seems like a narrow, technical
question. But the stakes of the answer are quite high for hospitals
because the greater the number of a hospital’s patients who fall
within the numerator, the more Medicare-reimbursement money that
hospital will receive.
II
The majority starts off on the right foot. “To
determine when a person is ‘entitled to supplementary security
income benefits,’ ” “we must know what the benefits are.”
Ante, at 6 (quoting §1395ww(d)(5)(F)(vi)(I)). But it quickly
missteps. According to the majority, because SSI entitles
individuals to “cash benefits,” and the eligibility for those
benefits “is determined on a monthly basis,”
ante, at 7, the
Medicare fraction counts only those patients who are eligible for a
cash payment under SSI during the month of their hospitalization.
This conclusion misunderstands both the benefit that SSI provides
and also, importantly, the reason
why Congress used SSI as
its proxy for identifying low-income patients.
A
The regulations accompanying the SSI statute
state that “[t]he basic purpose underlying the [SSI] program is to
assure a minimum level of income for people who are age 65 or over,
or who are blind or disabled and who do not have sufficient income
and resources to maintain a standard of living at the established
Federal minimum income level.” 20 CFR §416.110 (2024). We have
likewise explained elsewhere that “[t]he SSI program establishes a
federally guaranteed minimum income for the aged, blind, and
disabled.”
Schweiker v.
Hogan,
457 U.S.
569, 581–582 (1982).
At a high level, the SSI program works as
follows. Persons who are over 65, blind, or disabled may apply and
will be enrolled in the SSI program if their annual income and
financial resources are below a certain designated level. 42
U. S. C. §§1381, 1382(a)(1), (c)(7). Once approved—and
until that enrollment is terminated—an individual who is enrolled
in the SSI program is guaranteed an annual income above the federal
minimum. See §1382(b). This does not necessarily mean such an
enrollee will receive a check from the Government each month (or
even at all)—that depends on other specified factors. See §1382(c).
But if in any month an enrollee’s income drops below the rate
required to hit the federal minimum, the Government will pick up
the slack by sending them a check. See
ibid.
I pause here to note that participation in the
SSI program is thus highly beneficial to enrollees, regardless of
whether they happen to need and receive a check in any particular
month. This is so because being enrolled in SSI provides
participants with meaningful reassurance. Poverty in America is a
plague of uncertainty marked by persistent instability—what others
have called “the constant fear that it will get even worse.” M.
Desmond, Poverty, By America 17 (2023). The problem is not just
that one’s income is too low; it is that one’s income, such as it
is, is highly volatile. “For scores of American workers, wages are
. . . wobbly, fluctuating wildly not only year to year
but month to month, even week to week.”
Id., at 16. As one
woman living on the edge of poverty described her situation:
“ ‘[E]very day and every night when I’m trying to fall asleep,
there’s this worry hanging. . . . How am I gonna get
it done? How am I gonna stretch to get these bills paid? If one
extra thing happens—.’ ” D. Shipler, The Working Poor 25
(2004).
Congress understood this reality when it set out
to construct an income-related social safety net for the population
SSI covers. Indeed, the SSI program was specifically designed to
address the often debilitating state of low-income volatility. If a
person hovering at the poverty threshold is enrolled in the SSI
program, she has peace of mind that if she misses work because her
car breaks down, her child falls ill, or her work hours are
suddenly slashed, she will still be able to pay the bills because
the Government will provide her with some cash, if needed.
That is the true “benefit” of SSI—one less thing to worry
about.
This basic understanding of the SSI program also
helps to clarify the beneficiaries (
i.
e., it explains
who is “entitled to” SSI benefits for purposes of that statutory
scheme): anyone who, per the threshold statutory criteria, is
protected by SSI’s safety net in the first place. In other words,
an “entitled” person is any individual who has a right to receive
SSI payments when his income falls below the federal minimum.
The text and structure of the SSI statute
plainly comport with this understanding of both the SSI benefit and
what it means to be “entitled” thereto. The first substantive
provision of the SSI subchapter—notably titled “Basic
entitlement to benefits”—makes a promise: “Every aged,
blind, or disabled individual who is determined . . . to
be eligible on the basis of his income and resources shall, in
accordance with and subject to the provisions of this subchapter,
be paid benefits.” §1381a (emphasis added; boldface deleted). That
is clear enough. But
which individuals are “eligible on the
basis of [their] income and resources”? That question is answered
by the subsequent provision, §1382(a), which explains that any
“aged, blind, or disabled individual” with an annual income and
financial resources below a certain threshold “shall be an eligible
individual for purposes of this subchapter.”
Section 1382 then goes on to explain what an
eligible individual is eligible for under this program. Subsection
(b) guarantees each eligible individual payments from the
Government up to the statutorily defined federal minimum income
level over the course of a year, reduced by that individual’s
countable income for that year. §1382(b). And subsection (c)
provides that eligible individuals will receive a cash payment in
any month in which their monthly income falls below the amount that
would be required for them to earn the federal minimum over the
course of a year. §1382(c)(1).
Putting it all together: The SSI statute
distinguishes between an entitlement
to be enrolled in the
SSI program—promised in §1381a with eligibility criteria laid out
in §1382(a)—and the right
to receive a payment under the
program. Anyone who is in the former bucket gets the quite valuable
safety-net benefit of being enrolled in SSI (and the peace of mind
that comes with it), whether or not they actually receive a check
from the Government in any particular month.
B
Because the majority fails to appreciate the
programmatic nature of SSI, it reduces SSI’s benefit to the monthly
check—and nothing more. From that premise, the majority concludes
that all Congress cared about when measuring a hospital’s
low-income population for purposes of Medicare’s
disproportionate-share formula was the number of patients who
received a check during the month of their hospital stay. But the
majority also admits that the point of Medicare’s
disproportionate-share formula is to identify “ ‘hospitals
serving an “unusually high percentage of low-income
patients.” ’ ”
Ante, at 2. And whether an
individual received a check from the Government in a given month
does not track—and, indeed, has little to do with—the broader
“low-income” category of patients. The result is an interpretation
of the formula that not only strangely excludes indisputably
low-income patients, but does so arbitrarily.
Imagine a woman who has been eligible for SSI
payments for years and works at a retail store—I will call her Ann.
In January, Ann picks up a few night shifts, which pay more than
her usual day shifts. Cf. Shipler, The Working Poor, at 65. That
extra income bumps her above the SSI cash-payment threshold so she
does not get a payment in January. But in February (and March, and
April, and May), when her schedule returns to normal, her income
falls back below the threshold. In the majority’s view, whether Ann
counts as a low-income patient for purposes of the
disproportionate-share formula depends on the happenstance of her
hospitalization. If she has a heart attack in February, she’s in.
But if her heart fails in January, she’s out.
Why would Congress have intended to
exclude Ann from the hospital’s count of low-income patients in
January but include her in February? The answer is simple: It
didn’t. After all, the disproportionate-share formula is not about
Ann’s own personal cash flow—Congress was not trying to identify
those patients who lack cash on hand. Instead, as all agree, the
formula is trying to count those patients who will be costlier to
treat due to the health impacts of poverty. From the hospital’s
(and society’s) perspective, there is no cost difference between
treating Ann in January (when she had a bit more cash) or treating
her in February (when she had a bit less). In either month, in
terms of the hospital’s comparatively greater treatment costs, Ann
qualifies as a low-income patient.
The irrationality of the majority’s reading does
not end there. Under the majority’s view, also falling outside the
Medicare formula’s numerator are patients who happen to be
hospitalized during the first month they are eligible for SSI,
because, by statute, SSI payments do not kick in until the second
month of eligibility. See §1382(c)(7). Other quirks of SSI’s
statutory scheme—such as a provision preventing persons in
Medicaid-funded nursing homes from getting an SSI payment in any
month in which they have more than $30 in income,
§1382(e)(1)(B)—likewise mean that many of the lowest-income
patients are arbitrarily excluded from the disproportionate-share
formula’s count. Neither of these circumstances has anything
whatsoever to do with how costly it will be to provide such
patients with quality healthcare.[
1]
The majority does not mention these
incongruities, let alone justify them. Instead, it shrugs away all
of the apparent oddities of its interpretation, blithely noting
that “ ‘no statute pursues a single policy at all
costs.’ ”
Ante, at 15 (brackets omitted). I would think
the People’s representatives deserve more credit than to have this
Court conclude they intentionally enacted a statute that does not
reach its aims and operates so arbitrarily that it makes no
sense.
In the majority’s view,
my way of
analyzing the relevant statutes impermissibly elevates purpose over
text, because it “overlooks that Congress chose a specific means to
advance its end.”
Ante, at 15. But that contention simply
begs the question before us; what we are doing now is trying to
discern what it was that Congress “chose” when it referenced the
SSI program while crafting the Medicare fraction. The majority
apparently believes it can figure that out without considering what
the Medicare fraction was designed to accomplish—it just insists,
largely by
ipse dixit, that Congress “chose” a proxy for
low-income status that asks whether a patient received an SSI check
during the month of their hospital stay.
Ante, at 8–9, 15.
My response is simply,
why would Congress possibly make
that choice? The illogic of the majority’s interpretation
strongly signals that what the majority believes Congress “chose”
is not actually what Congress intended or accomplished.
There is also no
need to conclude that
Congress intentionally selected such an irrational and arbitrary
measurement when there is another equally (if not more) plausible
interpretation available: that Congress intended to count those
patients who were enrolled in the SSI program at the time the
hospital served them. Statutes “are not inert exercises in literary
composition,” but “instruments of government.”
United States
v.
Shirey,
359 U.S.
255, 260 (1959). We disrespect that instrument—and the coequal
branch of Government that has enacted it—when we fail to
understand, or appreciate, the logic of the laws Congress
designs.
C
There is yet another reason the majority’s
myopic approach to interpreting statutes has yielded the wrong
result in this case. As the majority envisions the SSI program, a
patient’s entitlement to SSI toggles off and on each month,
depending on her cash flow. That view of how the program operates
is flatly inconsistent with the fully contextualized reading that I
have laid out in Part II–A. It also conflicts with the statute’s
plain text, which clearly contemplates an SSI entitlement that
extends beyond a single month.
To understand how the majority goes awry on this
point, start where the majority does: with the language of
§1382(c)—a provision that explains
how and
when SSI
cash benefits will be paid. See
ante, at 7. By starting
there, the majority essentially ignores §§1382(a) and (b), which
plainly address
who is entitled to SSI benefits and
what they are qualified to receive due to that entitlement.
See also
Schweiker v.
Wilson,
450
U.S. 221, 223, n. 2 (1981) (“To be eligible for SSI
benefits,” a person’s “income and resources must be below the
levels specified in . . . 42 U. S. C.
§1382(a)”);
Sullivan v.
Zebley,
493 U.S.
521, 524 (1990) (“A person is eligible for SSI benefits if his
income and financial resources are below a certain level, §1382(a),
and if he is ‘disabled’ ”). Moreover, and importantly for
present purposes, subsection (a) eligibility looks to an
individual’s income over the course of a “calendar year”—not her
income in any particular month. §1382(a)(1)(A). Thus, the text of
this statute, read as a whole, plainly establishes that eligibility
for SSI benefits operates on a longer time horizon than the
majority acknowledges.
Other provisions further demonstrate that
whether someone is “entitled to” SSI benefits does not turn on
their income in a single month. After an individual applies for SSI
and is deemed eligible under §1382(a), she need not apply again the
next month—or, actually, any month thereafter—because her
eligibility for benefits lasts until her income is too high for one
full year, §1383(j)(1); 20 CFR §416.1335, or until her enrollment
is terminated for some other reason, §1383(e)(1)(A); 20 CFR
§§416.1331, 416.1333–416.1334. The statute also seems to
contemplate a longterm benefits relationship, insofar as it permits
the Department of Health and Human Services (HHS) in certain
circumstances to “
defer (in the case of initial entitlement)
or
suspend (in the case of existing entitlement)” SSI
benefits—a distinction that only makes sense if an individual’s
entitlement to SSI lasts beyond a single month.
§1383(a)(2)(B)(viii) (emphasis added); see also
§1382c(a)(3)(H)(ii)(I) (referring to an individual’s “continued
eligibility” for benefits over the course of multiple years).
If all that is still not enough to permit the
majority to accurately discern the broader confines of this
program, consider the fact that HHS requires SSI applicants to
grant the agency permission to access their financial records so
that HHS can automatically monitor their income.
§1383(e)(1)(B)(ii); 20 CFR §416.207. That authorization lasts until
“the cessation of the recipient’s eligibility for benefits under
this subchapter.” §1383(e)(1)(B)(ii)(II)(bb). But if eligibility
for SSI benefits were a monthly determination, the
give-us-your-records provision would accomplish nothing. It would
do the agency no good to have permission to access those records
for one month and one month only.
The practical realities of SSI administration
further demonstrate that the SSI entitlement is not determined
month by month. For example, SSI benefits are paid on the first day
of the month—an individual receives his February payment on
February 1st. 20 CFR §416.502. With its month-only entitlement
perspective, the majority thus apparently surmises that HHS
regularly pays benefits without knowing whether the recipient is
eligible for SSI at all. Any such policy would be surprisingly
irresponsible. But if SSI is a program that lasts beyond a single
month, day-one payments are both rational and administratively
feasible. Recall that we are talking about people who are
desperately in need of cash to pay their monthly bills; this
explains the agency’s practice of providing prompt, prospective
payments, which the aforementioned income monitoring facilitates.
Moreover, as I have explained, once an individual is approved for
SSI, he is entitled to receive such prospective payments, as
needed, until his enrollment is terminated. By adopting a broader
time horizon than the single month in which the payment is made,
the agency can get the money out to the needy individual and then
subsequently smooth out any over- (or under-) payments it makes, by
checking the person’s actual salary for the month in question and,
if necessary, adjusting the amount it pays in later months. See
§1383(b).
The majority simply ignores these kinds of
programmatic features that cut against its reading. And the
unhelpful statutory provisions that the majority does acknowledge
get short shrift in its opinion; in a footnote, the majority bats
them away as mere legislative “housekeeping.”
Ante, at 12,
n. 5. I grant that it is easier to duck Congress’s handiwork
than to explain the implications of its various policy choices. But
if the majority is going to base its interpretation exclusively on
what Congress “chose” when it used the term “eligibility,” it must
grapple with
all such usages of that term in the statute in
question—not just those that support its preferred
reading.[
2]
Notably, the design of the statute that creates
the SSI program—basic criteria establishing an entitlement to a
benefit, pursuant to which individuals are eligible for a payment
under certain conditions that are delineated elsewhere—is not
unique to SSI. Consider veterans benefits, for example. A veteran
“with the requisite period of military service becomes ‘
entitled
to’ ” certain educational benefits, “typically in the form
of a stipend or tuition payments.”
Rudisill v.
McDonough, 601 U.S. 294, 299 (2024) (emphasis added). But
just because a person is entitled to those benefits does not mean
she will ever receive them; there are hoops through which she must
jump and conditions she must satisfy to be eligible to receive a
payment.
Id., at 300–301.
Or consider Medicare Part A. “When a person
turns 65,” she “becomes ‘entitled’ to” Medicare Part A benefits.
Empire Health, 597 U. S., at 428 (quoting 42
U. S. C. §§426(a)–(b)). There, too, entitlement does not
guarantee payment—a person may be entitled to Medicare Part A
benefits yet never receive a single cent, perhaps because he is
covered by private health insurance, or because he has hit some
statutory cap on care. 597 U. S., at 432. As this Court has
recognized, “[t]he entitlement to [Medicare Part A] benefits” is
simply “an entitlement to
payment under specified
conditions.”
Id., at 436 (some emphasis deleted). The
same is true of SSI. Compare §426(c)(1) (explaining that
“entitlement of an individual” to Medicare Part A benefits
“consist[s] of entitlement to have payment made under, and subject
to the limitations in, part A”) with §1381a (stating that “[b]asic
entitlement to [SSI] benefits” consists of a promise to certain
individuals of payment “in accordance with and subject to the
provisions of th[e SSI] subchapter” (boldface deleted)).
III
It was precisely this distinction—between a
threshold entitlement to participate in a benefit program, on the
one hand, and a subsequent right to a payment under that program,
on the other—that was the linchpin of our interpretation of another
part of the disproportionate-share formula just three Terms ago. In
Empire Health, we faced a question that is substantially
similar to the one the Court decides today: Which patients are
“ ‘entitled to’ ” Medicare Part A benefits for purposes
of the disproportionate-share formula? 597 U. S., at 428. What
is more, the arguments in that case mirrored the arguments we
consider now. One side maintained that a patient is “entitled to”
such benefits only if she had actually received a Medicare payment;
the other insisted that a patient is so entitled if he was eligible
for the Medicare Part A program, no payment necessary. See
id., at 432–433. Notably, however, the valence of the
arguments was flipped—in
Empire Health, it was the hospitals
that insisted payment was required, while the Government asserted
program eligibility sufficed.
Ibid.
We sided with the Government. A patient is
“ ‘entitled to’ ” Medicare Part A benefits, we held, if
she “meet[s] the basic statutory criteria” for the Medicare Part A
program, whether or not she “actually receiv[ed] payment for a
given day’s treatment.”
Id., at 435. For purposes of the
disproportionate-share formula, we said, a patient’s receipt of
payment is beside the point. All the formula cares about is whether
a patient qualifies for the program that entitles her to payment
under specified conditions.
Id., at 436.
Exactly that same logic should have carried the
day here. A patient is “entitled to” SSI benefits for purposes of
the disproportionate-share formula if she “meets the basic
statutory criteria” for the SSI program, whether or not she
“actually receiv[ed an SSI] payment” in the relevant month.
Id., at 432, 435. In other words, just as with Medicare Part
A, statutory entitlement to SSI “coexists with limitations on
payment.”
Id., at 436.
Our reasoning in
Empire Health resulted
in hospitals receiving less money by operation of the Medicare
fraction.
Id., at 444. Applied here, that same logic
requires them to receive more, because it places more patients in
the numerator of the Medicare fraction. But instead of simply
following
Empire Health where it leads, the majority
diverges from its clear and plainly applicable holding. In the
majority’s view, although a patient need not receive a Medicare
Part A payment to be “entitled to” Medicare Part A for purposes of
the disproportionate-share formula, she must receive an SSI payment
to be “entitled to” SSI under that same calculation.
To justify this puzzling departure, the majority
identifies two “critical distinctions” that it says distinguish SSI
from Medicare Part A and thus make this case different from
Empire Health.
Ante, at 14. First, the majority says
that Medicare Part A benefits “extend beyond specified payments for
any given medical need,” whereas SSI benefits “consist of monthly
cash payments and nothing more.”
Ibid. I’ve already
explained why that characterization of SSI is wrong: The SSI
benefit is not simply the payment itself, but the
promise of
a payment in one’s time of need.
Supra, at 5–6. SSI thus
operates just like income insurance. Enrolled individuals are
promised a payout, should the relevant triggering event—monthly
income below the threshold—occur.
The majority rejects this commonsense conclusion
based on superficial mischaracterizations of the SSI program and
what it means to the people who rely on it. So, SSI is commonly
described as a “ ‘welfare program,’ ”
ante, at
13—so what? That label does not change the fact that
this
welfare program operates more like insurance than a subsidy. The
majority also seems to believe that insurance programs may protect
beneficiaries only against increased
costs—not decreased
income.
Ibid. But why is
that the case?
Economically speaking, increased costs and decreased income are two
sides of the same coin. The only difference is the precipitating
factor, and, of course, the fact that the decreased-income species
of insurance acknowledges the reality of income insecurity.
The second declared distinction is the
majority’s contention that Medicare Part A is “automatic and
ongoing” while SSI is not.
Ante, at 14. This seems faulty
from the start, since the majority concedes that disabled
individuals can lose their entitlement to Medicare Part A if their
disability diminishes.
Ibid. Thus, it is questionable
whether Medicare Part A is, in fact, “ongoing.” In any event, the
majority fails to explain why this “ongoing” distinction makes any
difference. The question before us is whether a person is “entitled
to” SSI for purposes of the disproportionate-share formula, not
whether a person must reapply to become so entitled, or whether it
is possible to be excised from this benefit program’s rolls.
Ultimately, then, neither of the “critical”
distinctions that the majority identifies between Medicare Part A
and SSI are critical at all. So, in the absence of any principled
basis for distinguishing this case from
Empire Health, the
majority falls back on pithy rhetoric, quipping that “ ‘it
makes little sense to say that individuals are “entitled” to the
benefit in months when they are not even eligible for it.’ ”
Ante, at 12. Again, this characterization misrepresents the
real benefit of SSI. It is also noteworthy that, while some on this
Court embraced a similar argument in
Empire Health, they did
so in dissent. See 597 U. S., at 447–448 (opinion of
Kavanaugh, J.) (arguing that a patient could not be considered
“entitled to” a Medicare Part A benefit “if the patient by statute
could not” receive a payment). The majority view in
Empire
Health fully appreciated the insurance-like nature of the
Medicare program, and its reasoning applies full bore to the
question we address today.
* * *
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.
Hospitals that have a disproportionate share of low-income patients
are struggling. Indeed, it is undisputed that systemically
undercounting low-income patients for the purposes of the
disproportionate-share formula might cause many such hospitals to
close their doors entirely, such that patients from our Nation’s
poorest communities may not be served at all. Brief for American
Hospital Association et al. as
Amici Curiae 27–28; Tr.
of Oral Arg. 36–38.
This outcome is not compelled by the text of the
Medicare statute or the circumstances that surround it. Rather, it
is, unfortunately, directly attributable to the majority’s
incurious and context-free method of statutory analysis. Congress’s
reference to the SSI program in the Medicare formula has confused
the majority into thinking that Congress meant for hospitals
serving low-income patients to be reimbursed at lower rates than if
their patient population was fully taken into account. So it will
now be up to Congress to restate its intention that low-income
people have access to quality medical care and that hospitals be
compensated accordingly.
I suspect that such a legislative fix would not
be too difficult to craft. But Congress would not need to go that
extra mile if this Court’s interpretive practices would just take
care to evaluate the text of a statute alongside any indisputable
legislative objectives. Here, we should have easily concluded that,
for purposes of the disproportionate-share formula used to
reimburse hospitals, patients are “entitled to” SSI benefits when
they are eligible for and enrolled in the SSI program, as Congress
undoubtedly intended.
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