Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1114_09m1.pdf
Page Number: 16

Cite as:  596 U. S. ____ (2022) 

13 

Opinion of the Court 

effect,  HHS  employed  option  2  but  did  not  differentiate 
340B  hospitals  from  other  hospitals—an  agency  practice
that was known in the wider hospital industry and in Con-
gress.

If HHS believes that this Medicare reimbursement pro-
gram overpays 340B hospitals, it may conduct a survey of
hospitals’ acquisition costs to determine whether and how 
much the data justify varying the reimbursement rates by
hospital  group—for  example,  reducing  reimbursement
rates paid to 340B hospitals as compared to other hospitals.
Or if the statute’s requirement of an acquisition cost survey
is  bad  policy  or  is  working  in  unintended  ways,  HHS  can 
ask Congress to change the law. 

Of  course,  if  HHS  went  to  Congress,  the  agency  would
presumably  have  to  confront  the  other  side  of  the  policy 
story  here:  340B  hospitals  perform  valuable  services  for 
low-income and rural communities but have to rely on lim-
ited federal funding for support.  As amici before this Court, 
many 340B hospitals contend that the Medicare reimburse-
ment payments at issue here “help offset the considerable 
costs” that 340B providers “incur by providing health care 
to the uninsured, underinsured, and those who live far from 
hospitals and clinics.”  Brief for 37 State and Regional Hos-
pital Associations as Amici Curiae 7.  As the 340B hospitals 
see it, the “net effect” of HHS’s 2018 and 2019 rules is “to 
redistribute  funds  from  financially  strapped,  public  and 
nonprofit  safety-net  hospitals  serving  vulnerable  popula-
tions—including patients without any insurance at all—to
facilities and individuals who are relatively better off.”  967 
F. 3d, at 840 (Pillard, J., dissenting).  In other words, in the 
view of those hospitals, HHS’s new rates eliminate the fed-
eral subsidy that has helped keep 340B hospitals afloat.  All 
of which is to say that the 340B story may be more compli-
cated than HHS portrays it.  In all events, this Court is not 
the forum to resolve that policy debate.

In sum, after employing the traditional tools of statutory