Levine says the ruling could prompt a reexamination of state policies that encourage integration through Accountable Care Organizations and other collaboratives encouraged by the Affordable Care Act.
"Then it could have an implication because if you are different practice groups or you are a (Physician Hospital Organization) and you want to do something because a state authorizes us to get together to create this sort of network, then if you are going to try to avoid antitrust scrutiny by pointing to that state mandate and saying there is a clear articulation of state policy to displace competition," Levine says.
"You are going to have to prove that your conduct was a foreseeable result of that state mandate and that now that foreseeability standard is not as loose."
Mark Pauly, a health economist at The Wharton School of the University of Pennsylvania, shares Levine's assessment about the impact of the high court ruling, and notes that only a small fraction of community hospitals are government owned.
"The proportion of community in hospitals in the United States that would have this kind of state protection is very small. It can't matter in most places," Pauly says. "The only statement that I thought was way out of line was the chairman of the FTC who said this decision is a big victory for consumers who want to see lower healthcare costs. Given that the community hospitals almost never have this arrangement with the state I don't see how it is a big victory for consumers."