Oral arguments before the Supreme Court on Tuesday in a case involving billions of dollars in Medicare payments to hospitals revealed a division among justices willing to show their cards.

The case, Advocate Christ Medical Center v. Becerra, concerns Medicare payments to safety net hospitals, known as disproportionate share hospital, or DSH, designed to compensate for the treatment of low-income patients. The more than 200 hospitals that filed the lawsuit argue that the federal Department of Health and Human Services does not pay them enough because it takes too narrow a view of which patients should be included in payments.

Two lower courts have already sided with HHS. federal appeals court stated in his decision He says the Medicare law at issue “at every opportunity” equates SSI eligibility with “cash payments,” so only patients who receive payments should be included in DSH calculations.

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