NEW YORK (TheStreet) -- HCA Holdings Inc. (HCA), which runs 155 U.S. hospitals, has argued vehemently against taking subsidies away from customers who buy insurance on federally operated exchanges but says it's well positioned even if the U.S. Supreme Court does just that.
Over the long run, rivals such as Tenet Healthcare (THC), and Community Health Systems (CYH) are unlikely to be significantly hurt either, said Morningstar analyst Vishnu Lekraj. Still, "there could be some near-term growth headwinds for some of these companies if the Supreme Court rules that subsidies are unconstitutional," he cautioned.
The crux of the Supreme Court case, King v. Burwell, is federal subsidies in 34 states that have federally operated exchanges, as opposed to state-run platforms. The petitioners in the case, including David King, argue that the Internal Revenue Service isn't allowed to extend the subsidies provided by the Affordable Care Act to those states because the law allows them only for exchanges run by a state. Without the subsidy, the 64-year-old King, a Virginia resident, would have been exempt from the law's requirement that he get insurance because his income was too low.
The government argued that King's interpretation is contrary to the spirit of the law, which was intended to provide more affordable health care coverage for all Americans. To function successfully, its three pillars -- the individual coverage mandate, a requirement that insurance companies provide coverage regardless of health history, and subsidies for those who can't afford insurance -- must be retained, according to a brief submitted on behalf of the U.S. Department of Health and Human Services and Secretary Sylvia Burwell.
HCA took a similar position in a separate brief submitted to the justices.
"The consequences of petitioners' interpretation are so absurd that the Congress could not possibly have intended them," the Nashville, Tenn.-based company argued. HCA has a significant stake in the decision, since 88% of its facilities are located in a state with a federally run exchange.
While uninsured patients typically pay nothing to HCA for the care they receive, those with insurance from the exchanges pay an average of $390 out-of-pocket per visit and are three times less likely to seek emergency-room care, which is more expensive than outpatient visits, the company said.
Further, "HCA has already incurred hundreds of millions of dollars in Medicare reimbursement cuts" under the affordable care law, known as Obamacare, HCA said in its Supreme Court brief. "Expanded insurance on the exchanges is beginning to offset these costs with new revenues."
That system would be disrupted if the subsidies are eliminated, HCA argued. In such a scenario, "the law comes apart at the seams, jeopardizing important achievements."
CEO Milt Johnson said at a Goldman Sachs (GS) health-care conference on June 9 that it's difficult to make backup plans if the subsidies are struck down because so much depends on the exact nature of the court's ruling and how quickly it would be implemented.
"We're watching [the Supreme Court decision] very closely," he said. Still, insurance provided through the exchanges accounted for only 2% of admissions in the first quarter, he said, "so the really good news is, regardless of how the Supreme Court rules, HCA is well positioned."
How health-insurance companies will be affected by the decision is less clear, but deal-making activity in the industry has heated up in recent weeks.
On Saturday, Indianapolis-based Anthem (ANTM) offered to purchase Cigna (CI) for $184 per share, the company said, an 18% premium on Cigna's closing price on Friday. On Sunday, the Bloomfield, Conn.-based target rejected the offer as "inadequate and not in the best interests of Cigna's shareholders."
Lekraj says that refusal was a mistake. "If I was a shareholder of Cigna, I'd be salivating over Anthem's offer," he added.
Christina Arnold, an analyst at Cowen & Company, agreed. "Anthem's proposed acquisition of Cigna makes strategic and financial sense," she wrote in a Monday note. 'Humana could potentially be the biggest loser from Anthem's pursuit of Cigna.'
Cigna's snub is only the latest development in recent merger drama in the health-insurance sector. Cigna and Aetna (AET) were in talks to purchase Humana (HUM), while UnitedHealth (UNH) moved to acquire Aetna, the Wall Street Journal reported.
"Consolidation is great for this industry if the government allows it," said TheStreet's Jim Cramer, portfolio manager for the Action Alerts PLUS charitable trust. "There is a presumption that it will. I do not know where that confidence comes from."
Lekraj, however, says deals in the industry are likely to receive government approval.
"These companies need to become bigger, which would allow them to price better," he said. "You need larger and more diverse memberships to offset pressures from the Affordable Care Act, and I believe the government recognizes that."