AHA Amicus Brief Challenges MultiPlan, Inc. Motion to Dismiss Antitrust Litigation

Interest of Amici Curiae

The American Hospital Association (AHA) represents nearly 5,000 hospitals, health care systems, and other health care organizations. Its members are committed to improving the health of the communities that they serve, and to helping ensure that care is available to and affordable for all Americans. The AHA educates its members on health care issues and advocates on their behalf, so that the perspectives of hospitals and health systems, along with the patients they serve, are considered in formulating health policy. One way in which the AHA promotes its members’ interests is by participating as amicus curiae in cases with important and far-ranging consequences.

The Federation of American Hospitals (FAH) represents more than 1,000 tax-paying community hospitals and health systems throughout the United States. Its members include teaching, acute, inpatient rehabilitation, behavioral health, and long-term care hospitals. They provide patients and communities in 46 states, the District of Columbia, and the Commonwealth of Puerto Rico with access to high-quality, affordable care, including inpatient, ambulatory, post-acute, emergency, children’s, and cancer services. Through advocacy and policy analysis, the FAH promotes market-based innovation, investments in the health care workforce, and the protection of access to full-service hospitals.

The AHA’s and FAH’s member hospitals have a significant interest in this case. Commercial insurance reimbursements comprise the majority of many hospitals’ revenue. Moreover, because government programs like Medicare do not cover the costs of providing care, commercial reimbursements can be the difference between losing money, breaking even, or earning a sustainable margin.¹ The AHA’s and FAH’s member hospitals thus depend on competition among commercial payors to ensure that commercial reimbursement rates are sufficient to cover hospitals’ costs and preserve access to care throughout the United States.

Introduction

This lawsuit comes at a crucial time for the health care sector. Since the onset of COVID-19, the prices for key inputs—including labor, prescription drugs, and medical equipment—have grown dramatically. America’s hospitals and health systems have borne the lion’s share of these increased costs. Government reimbursements were inadequate before the pandemic; they have since fallen even further behind. In December 2024, for example, the Medicare Payment Advisory Commission noted in a preliminary presentation to Commissioners that hospital Medicare margins were at an all-time low of negative 12.6%, and were projected to remain at that level in 2025.² These worrisome statistics do not include Medicaid shortfalls, which compound the problem even further. According to AHA analysis, the difference between Medicaid payments and costs in 2023 was $27.5 billion.³ And to make matters worse, reimbursements from commercial payors have failed to keep pace with hospitals’ increased costs. The result is dire: more than a third of all U.S. hospitals have negative operating margins, bond defaults are up, and hundreds of rural hospitals are on the brink of collapse.

The situation is much different for the commercial insurance companies that use MultiPlan’s repricing tool. Commercial payors like UnitedHealthcare are some of the largest companies in the world. They generate hundreds of billions of dollars in revenue each year and earn sizeable profits. In 2020, while hospitals were devastated by the COVID-19 outbreak, insurers banked record profits. Several years later, this economic divergence between providers and payors remains consistent. Hospitals and health systems continue to struggle financially. Insurers do not.

Against this backdrop, it is imperative that courts hold commercial insurers to the same standards as everyone else. The AHA and FAH respectfully submit this amicus brief to offer a broader perspective on what is really at stake here. If, as Plaintiffs allege, MultiPlan has facilitated collusion among commercial insurers throughout the country, this Court’s intervention will help preserve the viability of many struggling hospitals that cannot survive without competitive reimbursements.

Read the full amicus brief.

1. See Am. Hosp. Ass’n, The Financial Stability of America’s Hospitals and Health Systems Is at Risk as the Costs of Caring Continue to Rise, at 1 (Apr. 2023) (hereinafter “2023 Cost of Caring Report”), available at https://www.aha.org/system/files/media/file/2023/04/Cost-of-Caring-2023-The-Financial-Stability-of-Americas-Hospitals-and-Health-Systems-Is-at-Risk.pdf.
2. Alison Binkowski et al., Medicare Payment Advisory Commission, Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; and mandated report on rural emergency hospitals, at 13, 15 (Dec. 12, 2024), available at https://www.medpac.gov/wp-content/uploads/2023/10/Tab-D-Hospital-payment-adequacy-and-REH-mandate-December-2024_SEC-1.pdf. For this reason, the Commission recommended in January 2025 that Congress update Medicare payment rates for hospital inpatient and outpatient services by the current law amount plus 1% for 2026 and reiterated its recommendation to distribute an additional $4 billion to safety-net hospitals by transitioning to a Medicare safety-net index policy. See Dave Muoio, MedPAC Votes to Recommend Hospital Pay Increases for 2026, Fierce Healthcare (Jan. 17, 2025), available at https://www.fiercehealthcare.com/providers/medpac-votes-recommend-hospital-pay-increases-2026.
3. Am. Hosp. Ass’n, Fact Sheet: Medicaid Hospital Payment Basics (Feb. 2025), available at https://www.aha.org/fact-sheets/2025-02-07-fact-sheet-medicaid-hospital-payment-basics.