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States may become a party to the House Republicans’ lawsuit challenging cost-sharing reduction payments because they would suffer concrete injury if the payments ended, the U.S. Court of Appeals for the District of Columbia Circuit ordered yesterday. Fifteen states and the District of Columbia asked in May to in the House v. Price lawsuit, which challenges the federal payments to reduce out-of-pocket costs for low-income individuals purchasing coverage through the Health Insurance Marketplaces. “The States have shown a substantial risk that an injunction requiring termination of the payments…would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the States will have to provide health care,” the court said. “In addition, state-funded hospitals will suffer financially when they are unable to recoup costs from uninsured, indigent patients for whom the federal law requires them to provide medical care.” In a friend-of-the-court last year, the AHA and other hospital groups said ending the CSRs would harm patients’ finances and health, trigger a “death spiral” in the marketplaces, and force hospitals to shoulder an even greater financial burden.