Hospital chains can't move home-state Republicans on PPACA

“The answer to your question is no,” his office said in a statement. “From the beginning, Senator Alexander has led the fight against Obamacare.”

Alexander does believe Congress needs to help people who lose coverage if the court rules against the administration, his office said. He’s one of a number of Republican congressional leaders promising an as-yet unspecified plan to help people who lose health care subsidies if the Supreme Court rules against them.

The fear in the health care industry is that without the financial help, people would stop paying for insurance, except the very sickest. That would create what’s known in the industry as a death spiral, where the premiums of those who hold on to their coverage aren’t enough to pay claims, ultimately disrupting the market for even those who don’t get subsidies.

That means fewer patients showing up at hospitals with insurance to cover the services they need.

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HCA, based in Nashville, probably has the largest proportion of its profits tied to people who gained coverage on the federal exchanges. That’s in part because hospitals in Florida and Texas, two big states whose Republican governors opted to use the federal exchanges rather than creating their own, account for almost half of its revenue. The company, founded by the father of former Senate Republican Leader Bill Frist, has filed a brief at the Supreme Court in support of the PPACA.

“It is very important to us that reform continues,” HCA CEO Milton Johnson said at an investor conference last month. “We think it’s the right thing to do. We’ve supported reform from the beginning.”

HCA employees have given more than $436,000 in campaign donations to members of Tennessee’s congressional delegation. Johnson and his wife, Denice, account for $20,600. With one exception — a $1,000 contribution to Cooper  — all of the Johnsons’ money has gone to Republicans, including presidential candidates Mitt Romney in 2012 and John McCain in 2008 — both of whom have said they oppose PPACA. They have also donated to Black and to Chuck Fleischmann, another Republican representative from Tennessee who wants to repeal PPACA.

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Johnson wasn’t available for an interview, HCA said. In a statement, the company said it favors providing quality health care to more people.

The hospital industry splits its political contributions, according to data compiled by the Center for Responsive Politics. The American Hospital Association and the Federation of American Hospitals, which represents for-profits, split their political donations almost evenly between Democrats and Republicans in 2014. They favored Democrats in 2008 and 2010.

The press office of Corker, Tennessee’s other Republican senator, had no comment. Nor did three other representatives from districts near the hospitals’ headquarters. Tennessee has nine congressional districts, seven of which are held by Republicans.

One of the Democrats, Cooper, teaches health policy to graduate business students at Vanderbilt University. In a statement, he noted that the hospital companies based in the Nashville area backed PPACA and Gov. Bill Haslam’s failed attempt to expand Medicaid under PPACA.

 ”Nearly 155,000 Tennesseans are accessing health coverage through the federal exchange because Tennessee has declined to start its own,” Cooper said. “Those Tennesseans stand to lose their coverage if King prevails, and we are hopeful that the state will respond quickly and not allow them to be left out in the cold.”