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Ending the Affordable Care Act’s cost-sharing subsidies would harm patients’ finances and health, trigger a “death spiral” in the health insurance exchanges, and force hospitals to shoulder an even greater financial burden, making it harder for them to serve their communities, the AHA, Federation of ����������s, The Catholic Health Association of the United States, and Association of American Medical Colleges said in a friend-of-the-court brief filed Saturday in State of California, et al., v. Donald J. Trump, et al. “All of this suggests that the cost-sharing subsidies provided for under the Act should continue to be made,” the brief states. “Congress meant for the Act to create exchanges where lower-income patients could purchase affordable insurance that they could actually use. Without the subsidy payments, government expenditures under the Act will increase, which would be in tension with the Act’s goals.” Filed by attorneys general in California and 18 other states, the lawsuit seeks to prevent the administration from ending the cost-sharing subsidy payments.